Name:

Address:

Telephone:

Male Female

Did you graduate from High school? Yes No

Did you graduate from College? Yes No

What degree do you have?

What was your Major?

What are some of your interests? (Cut and Paste your answers into text box)

Do you have a pet? Yes No

What is your pet’s name?

What was the last movie you saw?

Did you like it? Yes No

What king of books do you read? Fiction Nonfiction

What was the last really good book you read?

Do you read magazines? Which Ones?