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| 1. Is your family a member of the club? |
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| 2. If yes, what programs do you participate in?
(Please check all that apply) |
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| 3. If no, how could the Club serve you? |
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| 4. Which of the following activities has your family participated in? (Please check all that apply) |
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| 5. Which of the following fund-raiser special events have you or someone in your family participated in? (Please check all that apply) |
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| 6. Which activities would you like see offered in our community that are currently not offered? |
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