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	PhoneE-mail
Please let us know if you are interested in participating in any of the following activities (check all that apply) Board GamesBird WatchingBadminton Ballroom DancingTalent ShowsTennis / Table Tennis Line DancingSpeed DatingShuffleboard Tea DanceChoir / Singing LessonsMovies Word Search (Sudoku)KaraokeHorseshoes BingoScrap BookingPiano Lessons DartsCreative WritingPoetry Chair MassageStand-up ComedyMeditation Herb GardeningPhotographyDay Trips Card GamesAerobic ProgramsOther 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? SundayThursday MondayFriday TuesdaySaturday 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