CLASS INTEREST SURVEY:
PAGE 1 - GENERAL

Class Interest Survey:
Page 1 - General

About You

Instructions: Please provide some general information about you. This information will NOT be linked to a name or email address, so is completely anonymous.

What is Your Gender?

Male Female No Answer

What is your Sexual Preference?

Gay Lesbian Straight
Bisexual No Answer

Relationship Status

Single Married/Partnered Dating
No Answer

What is your age? (enter 0 for No Answer)

City of Residence

State of Residence

Postal Zip Code (5-Digit)

Your Interests

Instructions: Please indicate your level of interest in taking Classes in the following topics using a scale from 1 to 5 with 5 being Very Interested, 3 being Possibly Interested/Unsure and 1 being No Interest at all.

Traditional Tantra Yoga

5 4 3 2 1

Western Tantra Sacred Sexuality

5 4 3 2 1

Reiki Training

5 4 3 2 1

General Massage Classes (non-erotic)

5 4 3 2 1

Please do not go backwards to change your answers. Once each page is submitted, it cannot be resubmitted.

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Do not underestimate good, thinking it will not affect you. Dripping water can fill a pitcher, drop by drop; one who is wise is filled with good, even if one accumulates it little by little.

- Buddha, Dhammapada 9.7

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Class Interest Survey:Page 1 - General

Class Interest Survey:
Page 1 - General