Centurions - Questionnaire

Questionnaire

Actives, please complete the following questionnaire by Wednesday, August 31, 2011. Your answers will appear in the retreat binder - and nowhere else - to help your fellow Centurions get to know you. Answers may be edited for length and style.

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First Name:
Last Name:
Company:
Business Address Line 1:
Business Address Line 2:
City:
State:
ZIP Code:
Office Phone Number:	() -Second partThird part
Cell Phone Number:	() -Second partThird part
E-mail Address:
Role in your organization:
Organizations with which you serve:
Birthday (without year):
Please describe any dietary restrictions or preferences:
Alma mater:
Family:
Worst job you ever had:
First car you owned:
Best event in Kansas City you've been to:
Favorite Kansas City restaurant:
Favorite local entrepreneur:
What others would find out about you if you starred in a reality TV show: