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* 1. What is your first and last name?

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* 2. Would you be interested in participating in a Health & Wellness Day?

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* 3. Which of the following activities interest you? Please check all that apply.

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* 4. Which of the following healthy eating techniques interest you? Please check all that apply.

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* 5. Would you be able to travel to Manhattan around late September-early October to participate in this day event?

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* 6. What day would work best for you? Please note this would likely be a full morning and afternoon event. Please check all the apply.

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* 7. If you have ever participated in a Health & Wellness event what did you like/dislike?

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* 8. What would your ideal Health & Wellness event include?

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* 9. Do you have any additional questions or comments?

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