UD Survey
Questions marked with an asterisk (*) are mandatory.
1
Who is your favorite author?
2
What was the last book you read just for fun?
3
If you could live at any time in history, when would it be?
4
If you could leave today, to which country would you travel?
5
If you could be any character from fiction, who would you be?
6
* Please list your High School (include city and state)
7
* Please provide your graduation year
8
* Please provide your address
Name:
Company:
Address:
City:
State:
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PQ
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Zip:
9
Please provide your email address.
10
Please provide your home phone number.