Please answer all questions if possible.

1. Are you a Veteran?
Yes
No
 

2. If yes, were you in a war?
World War I
World War II
Vietnam War
Korean War
Persian Gulf War
Other  (Please Specify)
 

3. If no, how are you related?
Mother
Father
Brother
Sister
Grandchild
Other   (Please Specify)
 

4. What branch of military are or were you in?
Army Navy Air Force
Marines National Guard Joint Forces
Army Reserves Navy Reserves
Coast Guard
Other (Please Specify)
 

5. Type of handicap or disability?
Wheelchair
Blind
Deaf
Loss of Limbs
Other
(Please Specify)
None
 

6. What type of place would you stay in if
overnight?
Cabins
Campsites
RV Sites
 

7. If cabin, what size would you prefer?
1 bedroom
2 bedroom
3 bedroom
4 bedroom
 

8. Do you have kids?
Yes
No
 

9. If yes, kids ages:
0-5 years old
6-12 years old
12-17 years old
18 years old and over
 

10. Do you smoke or chew tobacco?
Yes, I smoke cigerattes
Yes, I chew tobacco
Yes, I smoke pipe
Yes, I smoke cigars
None of the above
 

11. What sports do you like playing?
(Check all that apply)
Basketball Archery Badminton
Croquet Tennis Miniature Golf
Soccer Rodeo Tug of War
Softball Lacrosse Tetherball
Horseback Riding Bingo Ping Pong
Swimming Pool Game Computers
Playground Mountain Biking
Volleyball Billards (Pool)
Horseshoes  Paddle Boats
Other (Please Specify)
 

12. What would you swim in?
Indoor pool
Lake
 

13. What would you like in the store?
Soda  Chips  Lunch Meat  Milk
Candy/ Candy Bars  Camping Supplies
Bread    Eggs    Cheese
Other (Please Specify)
 

14. What kind of bait would you use?
Crickets    Nightcrawlers    Crawfish
Artificial Bait  Magic Bait  Minnows
Chicken Livers
Other (Please Specify)
 

15. Name for retreat?

 

16. What state do you live in?

17. What city do you live in? (Optional)