Burgundy Bistro Survey Form

*Your first name:**
*Your last name:**
*Enter your Email Address:**
*What town do you live in?:**
How often do you visit the Burgundy Bistro web site?	Every day Once per week Once per month Once per year
Which of the following restaurants have you eaten at in the last year?	Balagio Bamboo Blue Bogart's Burgundy Bistro Canoe Club Carlo's Cooper's Hawk Winery Flavor Fresh Starts Gatto's Glenwood Oaks Mr. Benny's Northwoods Tin Fish
Which of the Above listed restaurants is your favorite?
Why is it your favorite?
If there's a favorite restaurant of yours not listed above, what is it?:
When you eat out, what's your most popular choice of food?	Seafood Chicken Ribs Pasta Steaks and Chops Vegetarian
How often do you dine at Burgundy Bistro?	I have never dined at Burgundy Bistro Once a Year Once a month Twice a month Once a week Twice a week More than twice a week
Are you a member of our VIP Club? (to join, go to our Offers page)	No, not a member Yes, a member
Would you like to be a member of our Birthday/Anniversary Club? (the club where we buy you dinner!)	Yes No
To join, enter your birth month and day, and your address below:	Birth Month Birth Day
Enter your spouses birth month and day	Spouses Birth Month Spouses Birth Day
Spouses first name:
Enter your anniversary month and day	Anniversary Month Anniversary Day
If you're not on our mailing list, could we add you? Just fill in the address below.	Yes No Already on mail list
Street Address
City, State and Zip
Please enter your age range	Under 29 25-39 40-59 over 60
Please add any comments you have:

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