First Name:
Last Name:
Home Address:
City:
State:
Zip:
Where are you during the day? (zip code or area of town - downtown, north end, etc.)
Home Phone: (719-555-1212)
Day phone: (719-555-1212)
E-mail address:
Age: (optional)	18-24 25-34 35-54 55-64 65+
Race/Ethnicity: (Optional. White, Hispanic, Black, Asian, American Indian)
Do you currently subscribe to The Gazette?	Yes No
How frequently do you read The Gazette?	Please Select Daily Weekends only Few times a month Almost never Never
What is the best day of the week for you to participate?	Please Select Monday Tuesday Wednesday Thursday Friday
What is the best time of day for you to participate?	Please Select Mornings Lunchtime Directly after work Evenings
What would you hope to accomplish during your time on the Community Advisory Board?