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Marketing Questionnaire


NAME:  E-MAIL:
TELEPHONE:  FAX:
FIRM NAME:    
ADDRESS:  CITY, STATE, ZIP:
PRACTICE DESCRIPTION:
DESCRIBE YOUR CLIENTS:
DESCRIBE YOUR REFERRAL SOURCES:
ORGANIZATIONS IN WHICH YOU ARE INVOLVED:
OTHER INTERESTS (i.e., hobbies, sports, etc.):
UNDERGRADUATE SCHOOL:  YEAR GRADUATED :
GRADUATE SCHOOL:  YEAR GRADUATED :
SPOUSE'S NAME:  CHILDREN'S AGES:
 
PAST MARKETING ACTIVITIES (check all that apply):
 ARTICLES      SPEECHES      SEMINARS      NEWSLETTERS      BROCHURES      BOOKS    
 SOCIALIZING      RADIO      TELEVISION      ADVERTISING      ORGANIZATIONS      OTHER    
 
MARKETING GOALS:
 
MARKETING OBSTACLES:

SUBMIT THIS FORM TO (Choose One Person):