Personal Information:

First Name*
Last Name*
Address*
City*
State*
Zip*
Home Phone*
Work Phone
Date of Birth*
Email
Spouses Name
Anniversary Date
Spouse's Date of Birth
Spouse's Email

 

1. How did you hear about us?

BillboardHotelRadioTVDay Bus Trip
NewspaperOther

2. What sports activities are you interested in?

BaseballBoxingFootballGolfBasketball
Fishing

3. What kind of music are you interested in?

Big BandClassicalJazzPop/Top40Blues
Country-WesternRock and Roll

4. What kind of prize/merchandise do you prefer?

CashCasino ApparelJewelryTV/DVD/SteroOther

5. What casino game do you prefer the most?

BlackjackSlotsVideo PokerCrapsOther

6. In the last 6 months, how many times have you visited the casino?

1 Time2-3 Times4-6 Times7-12 Times13+ Times

 

Do you have any questions or comments?