Friends for a Greater Centralia

Friends for a Greater Centralia

Survey

* Name:
* Current/Retired Occupation:
Title:

Spouse:

Maiden:

* Address:

* City:		* State:		* Zip:
Phone Number:
* Email Address:

1.

Your answers to the CHS Tivia Challenge

1.
2.
3.
4.
5.
6.

2.	Do you have close family or friends living in the Centralia
	area?	Yes			No

3.	Would you be willing to be included in the effort to grow the
	greater Centralia area?	Yes			No

4.	Do you plan to attend the Fall Festival/Halloween Parade?
		Yes			No

5.	Do you plan to visit the area in the next year?
		Yes			No

6.	Please check areas of interest.
		Providing contact names			Serving on planning committees
		Making direct business contacts			Funding community and scholarship projects
		Personally investing in the community			Relocating/retireing in the greater Centralia area
		Other areas of interest (Please specify below.)

Click the Button Below To:

Then Wait for Acknowledgment.

Note:

* These items are required.