Which of the following best describes your household?

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* 1. Which of the following best describes your household?

I live in Town?

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* 2. I live in Town?

Of the following, what would you be interested in doing at the new community center?

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* 3. Of the following, what would you be interested in doing at the new community center?

I would be interested in utilizing the new fitness center during the following hours of the day.

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* 4. I would be interested in utilizing the new fitness center during the following hours of the day.

  7 am - 8 am 8 am - Noon Noon - 4 pm 4 pm - 9 pm
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
I could volunteer:

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* 5. I could volunteer:

  Daily Weekly Monthly As Needed
1-2 hours
2-4 hours
4-6 hours
6-8 hours
8-10 hours
10-12 hours
I would willing to volunteer for the following responsibilities at the new community center:

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* 6. I would willing to volunteer for the following responsibilities at the new community center:

Contact Information (Optional)

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* 7. Contact Information (Optional)

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