Request for your information to be used in keeping you informed of events and activities at Westminster Village

Name:
Address:
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Do you have e-mail?	Yes No
Your e-mail address:
Westminster Village will send e-mail invitations to seminars, open houses and other special events.
Are you still interested in Westminster Village?	Yes No
If Yes, Please check all that apply:	WV Apartments Assisted Living at Westview Wing The Willows Martin Health Center
Are you inquiring for yourself?	Yes No
For others?	Yes No
Relationship:
Do you wish to continue to receive?	Newsletters: Yes No Invitations to Open House: Yes No Invitations to Seminars: Yes No Special Events: Yes No
I am not interested in moving to Westminster Village, but still want to receive The Villager Newsletter:	Yes No
Did you inquire by?	Phone Letter Walk-in Internet
Did you receive information promptly?	Yes No
Was the person you spoke with: (check all that apply)	Informed Helpful Polite Efficient Other
Did the material provide the information you needed?	Yes No
Did you have a tour of Westminster Village?	Yes No
If Yes, tour was given by?
Is there any other information you need?