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Reader Questionnaire Example |
Last Name:
____________________________________________
First Name: ___________________________________________
Profession: ___________________________________________
Special Hobbies or Interests:
_______________________________________________________
_______________________________________________________
_______________________________________________________
Membership in Organizations, Associations or Political
Parties:
_______________________________________________________
_______________________________________________________
_______________________________________________________
Age: __________________________________________________
Address: ______________________________________________
Street: _______________________________________________
City: _________________________________________________
Telephone: ____________________________________________
Fax: __________________________________________________
Email: ________________________________________________
Check Preferred Reading Times:
28 Thursday: __
29 Friday: __
30 Saturday: __
1 Sunday: __
19:30-20:30: __
20:30-21:30: __
21:30-22:30: __
22:30-23:30: __
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