* 1. Community Name:
(Please use the name of the Municipality in which you reside and receive a tax bill from or First Nation Community)

* 2. What is your street address? (i.e. 123 John St.)

* 3. GPS Coordinates (if known)

* 5. Have you/will you conduct a speed test at Connectednorth.ca?

* 6. If you receive high speed internet, what method do you use to receive your service?

* 7. If you receive high speed internet, are you satisfied with your service?

* 8. Please specify what type of activities you and your family would, or do access on line:

* 9. If improved broadband service were made available, would you be willing to pay approximately $50/month for residential and $100/month for business service? (these are typical prices for service)

* 10. Do you believe advanced communications services to be important for the community, inhabitants and businesses?

* 11. What is the single most important criteria for your internet connection:

* 12. Any additional comments?

* 13. If you would like to speak with us regarding your quality of internet service, please leave your name and contact information and we will follow-up with you as soon as possible.

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