1. Please Tell Us About Yourself
	Name Company Address 1 Phone Number 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 Email Address

	2. When Did you Visit?
	hh:mm 00:00 00:30 01:00 01:30 02:00 02:30 03:00 03:30 04:00 04:30 05:00 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 17:00 17:30 18:00 18:30 19:00 19:30 20:00 20:30 21:00 21:30 22:00 22:30 23:00 23:30

	3. What Did You Notice First?

	4. How Were You Treated?
	Cold Shoulder Below Average Average Friendly Very Friendly 1 2 3 4 5

	5. What Did You Like Best?

	6. Did Your Children Have a Good Experience?
	Had A Fantastic Time! Had a Good Time! Was A Little Bored! Hated It! I Do Not Have Any Children!

	7. Where You Able To Make Your Way Around Our Facilities?
	YES NO

	8. Overall Impression of Our Facilities?
	Not Impressed at All Slightly Unimpressed Average Impressed Very Impressed 1 2 3 4 5

	9. Overall Impression of Our Worship Service?
	Not Impressed at All! Slightly unimpressed Average Impressed Very Impressed 1 2 3 4 5

	10. Do You Plan On Visiting Again?
	YES NO

	11. Is There Anything Else You Would Like To COMMIT ON?

	12. How Can We Pray for You?

	THANKS FOR VISITING EASTVIEW WESLEYAN CHURCH WE HOPE TO SEE YOU AGAIN!!