* 1. Name:

* 2. Email Address:

* 3. Phone Number:

* 4. How did you hear about our organization?

* 5. What has prompted you to donate in the past? (select all that apply)

* 6. Has the farm been responsive to you as a donor? 

* 7. How likely are you to donate again?

* 8. How would you like to be contacted?

* 9. Birthday (optional):

* 10. Comments:

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