Date:

Name:

Address:

City:

ST:

Zip:

Reading Preferences (Please check all that apply):

Magazines

Sci-Fi

Romance

Fiction

Self-Help

Travel

Biographies

Cooking

New Age

Which store do you visit most often?

Michigan Avenue

Union Street

Fleet Street

How often do you visit our stores?

Comments and/or Suggestions:

When the form is complete, press Submit. Thank you!