1. Please describe in complete sentences what a community center would mean to you and your family. Can we make your statement above publicly viewable with your name? We will not post your address, e-mail address, phone number, age, or any other information. Yes 2. Name 3. Number of household members 3. Ages of household members, separated by commas 4. Mailing address 5. E-mail address 6. Phone number 7. What would you most like to see at our community center? Click below all that apply to you. Technological Center Greenhouse Food Co-op Health Care Services Public Park Recreational Facilities Other: 8. Would you like to be placed on our mailing list to receive up-to-date information regarding the progress of the community center? Yes 9. Are you interested in contributing to the community center, either through donations or by volunteering your time? If yes, please explain: That's it! Thank you one more time for filling out the survey! If you are having problems submitting this form, please, contact us.