Gender

               Male    Female

Which age category identifies you:

          12-14 15-19 20-24 25-29 30-39 40-49 50-59 60-69 70+

Marital status

        Single(never married)    Single(divorced)    Single(widowed)

        Married    Married(blended family)

I first heard about Lakeside from:

             Friend    Internet     Newspaper     Lakeside Shorelines Newsletter

My first impression of Lakeside was (check all that apply):

            warmly welcomed  openly accepted  genuinely loved  Wow! God is in this place.

            cold indifference    religious judgment boredom  alienated  I have not attended Lakeside.

What kind of comment would you like to send?

Complaint Suggestion Problem Praise

 

I (we) participated in a Lakeside:

          Weekend Worship Community Outreach EventSmall Group Study Other:

What about us do you want to comment on?

Web Site Worship Experience (Other) Other:

Enter your comments in the space provided below:

Tell us how to get in touch with you:

Name
E-mail
Tel	- -
FAX	- -

Please contact me as soon as possible regarding this matter.