Request for Printed Copies of Eating Fruits and Vegetables Fresh and Clean
Please complete and submit the form below. * indicates required fields
* Name:
* Street:
* City:
* State/Province: * Zip/Postal Code:
Country:
E-mail:
* Number of Copies: 1 2 3 4 5
To help us design new educational materials, please tell a little about yourself and your intended use of this brochure. This area of the Request Form is completely optional. Your responses will not be shared with anyone, at any time, unless required by law.
Occupation - which of the following best describes you?
Extension Agent/Specialist
Nutrition Professional
Health Conscious Consumer
Other, please specify
How did you find out about this webpage/brochure?
Search engine
Link from another website
Word of mouth
E-mail
How do you plan to use the printed brochure? (Check all that apply)
Personal use
Share with family and/or friends
Resource for teaching a class
Distribute to a group
Did you print this webpage?
Yes
No
What did you like most about the online brochure? (Check all that apply)
Colorful
Easy to understand
Photos
Useful information
Recipes
Attractive layout
Reinforced some things I already knew
How would you rate your food handling practices?
Very safe
Safe
Need improvement
Ethnicity - which of the following best describes you?
White, non-Hispanic
Black, non-Hispanic
Other, non-Hispanic
White, Hispanic
Black, Hispanic
Two or more races mixed
Age
18-44
45-59
60-75
76 and over
Sex
Female
Male