First Name:
Last Name:
Address:
City:
State:
Zip:
Other Country:
Email:
I am:
Female
Male
Age:
Less than 13 years old
13-19
years old
20-29
years old
30-39
years old
40-49
years old
50-59
years old
60-69
years old
70
years old or older
Education level:
I'm still in school (grades K-12)
I did not graduate from High School
High School Graduate
Some College or Tech School
College Graduate
Graduate Degree
Total household income:
Less than $15,000
$15,000-$24,999
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000 or above
Are you a member of The
Children's Museum? Yes
No
How did you hear about our museum?
Newspaper/Magazine/Newsletter
Radio
Phone Book
Website/Internet/Search Engine
Welcome Center/Rest Area
Television
Advertisement
Brochure
Word of Mouth/Recommendation
Banner/Sign/Billboard
Have you visited our museum? Yes
No
When do you plan on visiting the museum again or for
the first time?
Within 1 month
1-3
months
4-6
months
7-11
months
12
or more months
Not planning to visit
How many children or grandchildren do you have that
are less than 13 years old?
How would you rate our website?
Excellent
Good
Fair
Poor
Comments, Questions or Suggestions:
