form - somewhereville.com/gnw

Due to spam (mainly from robots), it has become necessary for me to require several of the following fields. Each of these required fields is marked with a red *.

None of the information you provide on this form will be used for any purpose other than facilitation of my response to you. Thus, if you wish, you may provide a bogus name and/or email address. Please note, however, that if the email address you provide is fake, I cannot respond to you. If you do choose to give a false email address, please leave the "Fake" radio button checked so that I do not send a reply; else select the "Real" one.


First Name*


Last Name


Email Address*

Real
Fake

Comments, questions, suggestions, etc...*


Any specific reason for being here (research, interest, etc.)?


What did you enjoy the most?


What did you least enjoy?


What would you change?


How did you find this website?



purely demographic stuff

Where are you from?
     

About how old are you?




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Thank you for your time.

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this webpage was last updated 02:17 09-Feb-13 est.