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:
Your answer
2.) Address:
Your answer
3.) Phone:
Your answer
4.) Email:
Your answer
5.) Birthdate
Your answer
6.) Race
Your answer
7.) Marital Status
Your answer
8.) Gender
Your answer
9.) Date of Registration
Your answer
Getting to Know You
1.) Are you currently a Lawrenceville United member?
Your answer
2.) How long have you lived in Lawrenceville?
Your answer
3.) Do you live by yourself?
Your answer
4.) How many in your household?
Your answer
5.) Do you rent or own your house?
Your answer
6.) Do you currently attend your neighborhood block watch?
Please include the reason for your answer:
Your answer
7.) What top 3 businesses in Lawrenceville do you support or visit the most often?
Your answer
8.) Have you or your family attended any recent community events or meetings?
If so, please list the most recent:
Your answer
9.) Are you a member of the Lawrenceville Healthy Active Center and/or the Lawrenceville Senior Center?
Your answer
Lawrenceville United will be mailing you additional information regarding the program once you have registered by submitting this form.
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