QUESTIONNAIRE

PLEASE CIRCLE OR WRITE IN whatever applies in the questionnaire below. Attachments are welcome. The more I know about this person, the better gift I can produce for you. Please fill out this form to the best of your knowledge. If possible attach a rough story or explanation about this person and I will write it in final format of a poem or a story.

Name of person ordering this gift?

How can I get in touch with you and keep gift a surprise?

Full name or nickname of person signing and giving gift?

Full name or nickname of person I will be writing about?

In what style(s) would you like your gift to be written:

(Serious) (Humorous) (Serious and Humorous) (Hillbilly) (Valleygirl) (Tears) (No Tears)

What most describes the person we are writing about (circle as many as you like):

(Singer) (Dancer) (Movie Star) (Valleygirl) (Cowboy) (Cowgirl) (Snow Boarding) (Snow Skiing) (Water Skiing) (Tennis) (Golfer) (Music) (House Wife) (Other)

Color of hair? Color of eyes? Weight? Height?

Children's names?

Hobbies: (cooking) (knitting) (fishing) (hunting) (watching TV) (other)?

Favorite Color? Favorite Food(s)? Favorite Drink?

Pets: (Horse) (Dog) (Cat) (Other) Name of Pet(s)?

Vehicle they drive, color, make, is it important to them?

How did you meet person?

What day did you meet?

Where did you meet person?

Religion is a personal issue, would you prefer it be included?

If so please explain the person's beliefs (choice of faith, etc.)

INTENTION OF THIS POEM or STORY: (Thank you) (I love you) (Mothers Day)( (Fathers Day) (Birthday) (Sweetheart) (Friendship) (Propose for Marriage) (Marriage Vows) (Makeup from a fight) (Having a Baby) (Anniversary) (Getting a Prize or Award) (You offended them, now you want them back) (Christmas) (Other) (Graduation) Please explain:

What are you trying to accomplish by giving this poem or story as a gift?