Which of the following areas do you feel are lacking and/or need attention in our community? (Check all that apply.)	Youth Activities Social Issues Community Improvement Programs for Senior Citizens Personal Development Family-Oriented Activities
Do you have any suggestions for programs or activities you would like to see in our community?	Please type your suggestions here.
Would you volunteer two hours a month to benefit your community?	Yes No
How long have you been a member of this community?
If you have children, how many do you have?
Contact Information:	Name Address Phone E-Mail
How did you hear about the Jaycees?
Comments: