* 1. First Name

* 2. Last name

* 3. Will you be attending Sampler Day 2015?

* 4. When you were last here on campus, what did you do? Please choose all that apply.

* 5. Email Address

* 6. 5-digit Zip Code

* 7. Which topics are you most interested in sampling?

* 8. Are you planning to take a Continuing Education course in the spring?

* 9. Please check all ways you heard about Sampler Day

* 10. 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)

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