Welcome to the Gilded Serpent Community!

Please fill in the survey below, and include any comments or suggestions you might have.

This info will not be sold, it's just to help us see who's coming to read us and what you might be interested in. THANKS!

	NAME:
	ADDRESS:
	CITY:
	STATE:	ZIP:
	EMAIL:
	DO YOU HAVE A WEBSITE?	Yes No
	URL:

Have you heard of Gilded Serpent before today?

Yes No

Which of the following do you attend?

workshops
group classes with one teacher
group classes with more than one teacher
private lessons
retreats for music or dance
nightclubs/restaurants with Middle Eastern music or dance

What term best describes you?

Musician:	Level:
Dancer:	Level:
Vendor Fan

Age group:
Gender:
Income Level:
Occupation:
Where do you live?

How much do you spend on Bellydance products and services per year? (costuming, lessons, etc.)?

How much do you spend on Middle Eastern Products in general per year? (décor, cooking items, etc)?

Where do you typically purchase these items? (check all that apply):

Online:
Music Video Books DVD
Complete Costumes Supplies
Props-zils,canes,etc. Gift Certificates

Retail:
Music Video Books DVD
Complete Costumes Supplies
Props-zils,canes,etc. Gift Certificates

I access the Internet:

I have a DVD Player:

DVD Player that connects to my TV
DVD Player in my computer
I don't have a DVD Player

What do you teach?	Dance Music Both
# of beginning students I taught this last year is:
# of beginning student I have taught in my teaching career is:
# of professional musicians/dancers I have produced so far is:

I would be willing to participate in a more detailed reader survey.

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Feedback, comments, suggestions:

Thank you!