Fall 2015 Sampler Day Registration Question Title * 1. First Name Question Title * 2. Last name Question Title * 3. Will you be attending Sampler Day 2015? Yes No Question Title * 4. Email Address Question Title * 5. 5-digit Zip Code Question Title * 6. Which sample classes are you planning to attend? (Choose all that apply.) Conversational Italian Fundraising Basics Getting Ready for a Marathon Introduction to Adobe Flash and Photoshop Life and Music of Bob Dylan Makeup Tips and Tricks Meditation Memoir Writing Poetry Writing Russian Fairytales and Folklore Tai Chi The Business of Craft Beer The Path to High Performance Question Title * 7. Which other topics are you interested in learning more about through Continuing Education? Question Title * 8. Please check all ways you heard about Sampler Day Email COD Continuing Education website COD Lifelong Learning website COD Sign COD Calendar of Events Local Media Friend Other (please specify) Question Title * 9. Do you currently receive the Continuing Education schedule at your home? Yes No Question Title * 10. Please enter your mailing address if you would like to receive a schedule of Continuing Education classes. Question Title * 11. If you would like this survey to serve as your registration for the Sampler Day event and as your entry into the raffle, please indicate your full birthdate below (Sample: Feb. 14, 1950) Done