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1. Full Name

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2. Club Member Number (if applicable)

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3. What is your age?

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4. Which race/ethnicity best describes you? (Please choose only one.)

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5. What is your relation to the Boys & Girls Clubs of Greater Houston?

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6. What Club are you linked to?

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7. Why did you decide to join / give to / volunteer with the Boys & Girls Clubs?

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8. Please list three things you like most about your membership / support / volunteer work and why you like them.

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9. What do you see as the most valuable aspect of your participation / advocacy / membership / volunteer work?

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10. Please tell us about any specific success that your involvement with Boys & Girls Clubs helped you achieve and how?

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11. How has your involvement with Boys & Girls Clubs improved your life or your community?

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12. Is there anything about your membership / volunteer work that you would like to see changed?

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13. May we use your comments in our communications with attribution?

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14. How may we contact you? Please include email address and/or phone number.

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15. Do you have any other comments, questions or concerns?

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