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* 1. Please enter your name, mailing address, telephone number, email address and other information so we can ensure our membership records have your correct information.

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* 2. There are many ways the Senior Center can communicate with our members.  Place a check next to the ways you would like to receive information.   You can check multiple boxes.

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* 3. What activities/events have you attended in the past?  (multiple checkboxes can be checked)

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* 4. What other events or activities would you like to see held at the Center (see examples below or add your ideas under "Other")

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* 5. How many times do you visit the Alexandria Senior Center?

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* 6. Have you ever visited a Senior Center elsewhere?  If so, which one and why did you attend?  What did you like at that Center?

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* 7. We are looking at reopening the Senior Center since we temporarily closed it due to COVID-19.  We will reopen when it is safe and we will share what we are doing to make it safe.  This information will be communicated in many ways, so look for this information in the newsletter, Facebook, email, text, etc.

What is your comfort level for the Senior Center to be reopened and for you to join in activities?

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* 8. Are there any Senior Center activities you would like to join in on while you are staying at home?  These could be virtual activities, something like joining in Zoom gatherings (this does require a computer and internet connectivity):

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* 9. As you know, providing activities at the Senior Center gives our members a lot of opportunities to volunteer, which helps keep our costs low.  Check the boxes below if you are interested in volunteering.

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* 10. Senior Center website questions:   Check the checkbox to answer "Yes"     Leave the checkbox unchecked to answer "No"

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