Questionnaire Filer #:
|
|
E-Mail Address:
|
|
How old are you:
|
|
Salutation:
|
|
Full Name:
|
|
Position:
|
|
City / State:
|
|
Your Country:
|
|
Home Phone Number:
|
|
Work Phone Number:
|
|
Fax Number:
|
|
Pager Number:
|
|
URL:
|
|
I'd like to know a little bit about you for my files:
|
Tell me, who are you? Describe yourself!
|
|
What do you hope to get by filling out this form?
|
|
When will you be in the San Francisco Bay Area?
|
|
Do you smoke cigars?
|
|
Do you light cigars?
|
|
Do you ride a motorcycle?
|
|
If so, how big is it?
|
|
Are you a techno-weenie, or a workaholic?
|
(Select Multiple)
|
Are you a psycho, a chronic liar, a murderer?
|
(Select Multiple)
|
What do you eat??
|
|
What do you regret?
|
|
How did you find this page?
|
|
Do you have any of these?
|
(Select Multiple)
|