Lawrenceville United Senior AdvantAGE Program

1.) By completing this survey, you will be formally registering for the Program. Your information will help us to better identify your needs and requests and will allow us to keep you posted on events and opportunities.
2.) Keep in mind that all provided information will be kept confidential by LU; we will not reveal individual responses to any outside sources.
Contact Information
1.) Name:
2.) Address:
3.) Phone:
4.) Email:
5.) Birthdate
6.) Race
7.) Marital Status
8.) Gender
9.) Date of Registration
Getting to Know You
1.) Are you currently a Lawrenceville United member?
2.) How long have you lived in Lawrenceville?
3.) Do you live by yourself?
4.) How many in your household?
5.) Do you rent or own your house?
6.) Do you currently attend your neighborhood block watch?
Please include the reason for your answer:
7.) What top 3 businesses in Lawrenceville do you support or visit the most often?
8.) Have you or your family attended any recent community events or meetings?
If so, please list the most recent:
9.) Are you a member of the Lawrenceville Healthy Active Center and/or the Lawrenceville Senior Center?
Lawrenceville United will be mailing you additional information regarding the program once you have registered by submitting this form.
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