Columbia Student Solidarity Network

Information Survey

The purpose of this survey is to collect information about who visits this web site. It has been implemented out of sheer curiosity about who visits this site. However, if you fill out the form accoridngly, the information contained on this form will be used to add you to our e-mail and phone list in order to keep you updated about weekly meetings as well as other events.

Please fill out this section as comletely as you like. Keep in mind that if you want to added to our mailing list you must provide either a name or phone number.

  1. Would you like to be included on the mailing list?

    Yes No

  2. How many hours do you spend on a computer per week?: (All usage, not just internet)

    < 2 hours 2-5 hours 5-10 hours More than 10 hours

  3. We would like to keep you informed! Please tell us how to contact you.
    				Name  
		  Where are you from? 
			       Phone  
		      E-Mail Address
  1. Please enter any additional comments:



FORM SUBMISSION

Thank you for taking the time to answer the questions in our survey.

By Benjamin J. Dubin-Thaler
Revised: October 09, 1997.