Marks Street Senior Ctr

Date*	First Name*
Middle Initial	Last Name*
Age	Home Phone*
Cell Phone	Email Address*
Address*	City*
State* AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UM UT VA VI VT WA WI WV WY	Zip Code*
Best Way to Contact	Phone E-mail
Please let us know if you are interested in participating in any of the following activities (check all that apply) Board Games Bird Watching Badminton Ballroom Dancing Talent Shows Tennis / Table Tennis Line Dancing Speed Dating Shuffleboard Tea Dance Choir / Singing Lessons Movies Word Search (Sudoku) Karaoke Horseshoes Bingo Scrap Booking Piano Lessons Darts Creative Writing Poetry Chair Massage Stand-up Comedy Meditation Herb Gardening Photography Day Trips Card Games Aerobic Programs Other Sports Activities
Day Trips (Please Be Specific) Characters left: 1800
Card Games (Please Be Specific) Characters left: 1800
Aerobic Programs (Please Be Specific) Characters left: 1800
Sports Activities (Please Be Specific) Characters left: 1800
Please list anything not mentioned above that you would like to see here at Marks Street Characters left: 1800
Help us learn a little bit more about our guests by answering the following questions!
Do you use a home computer?	Yes No
Do you have access to the Internet?	Yes No
Have you visited our website (http://www.orangecountyparks.net)?	Yes No
Where did you first hear about our facility? Characters left: 1800
What is your favorite activity at Marks Street? Characters left: 1800
What days of the week are you available for activities? Sunday Thursday Monday Friday Tuesday Saturday Wednesday
What times are best for you? Mornings 8-11 AM Afternoon 12 -1 PM Evenings 5-8 PM
Additional Comment / Suggestions To Help Us Improve Characters left: 1800