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* 1. What types of physical activity would you like to see in Mineola? (check all that apply)

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* 2. Where do you go most often for physical activity? (check all that apply)

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* 3. If your employer offered access to a wellness program, would you participate?

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* 4. How important do you think it is for your place of employment to offer a worksite wellness program? (check one)

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* 5. How often do you visit the public parks in Mineola?

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* 6. Do you currently live in....(check one)

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* 7. Looking at the map below, which zone best reflects your address?

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* 8. Map of Mineola

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* 9. How many people currently live in your household?

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* 10. What are their ages?  (check all that apply)

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* 11. If you would like more information on Active Living, please leave your email address.

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