re: 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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