Film Series: Private Violence at the Madison-Morgan Cultural Center

Question Title

* 1. Please rate this film:

Excellent

Good

Fair

Comments

Question Title

* 2. What did you learn from this film?

Question Title

* 3. Did this experience have a significant impact on your life? If so please explain:

Question Title

* 4. How did you hear about this film?

a brochure in the mail

internet search

a newspaper or magazine listing

an email

Facebook or Twitter

word of mouth

Other (please specify)

Question Title

* 5. Where do you live?

City

County

State

Question Title

* 6. Do you attend other films?

Yes

No

If so, where?

Question Title

* 7. Are you a member of the Cultural Center?

Yes

No

Question Title

* 8. Please contact me about...

Events, programs, art exhibits at the Center

Volunteering

Becoming a Member

Becoming a Sponsor

Question Title

* 9. Contact Information

Name

E-Mail

Street Address

City/State/Zip