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Activity Survey for Seniors in Anderson Valley - Please indicate the activities that you would like to have offered or any other suggestions below.

1.Monthly AV Village Presentations (Please check all that apply):
2.Outings (Please check all that apply):
3.Classes & Activities (Please check all that apply):
4.Are you willing to give a presentation, lead an outing or activity and/or give a class?
5.Please indicate your preferences for days for when activities would be offered (Please check all that apply)
6.Please indicate your preferences for timing when activities would be offered (Please check all that apply)
7.Please indicate your preferences for timing for when activities would be offered in relation to the senior lunch (noon to 1 PM on the 1st, 3rd &4th Tuesdays & every Thursday) 
8.Please indicate the level of participation you feel you would want, i.e. I would like to participate (Please check all that apply):
9.If you would like to be contacted about these activities please provide your contact info: