Location Name:

Year Established at Location:

Address:

City / State or Province / Zip or Postal Code:

Telephone Number:

Email Address:


Location Type:
Select One Golf Course Excercise Facility Racquet Club Supermarket Aquatic Center Community Center Other (Describe Below)
If other, explain.

Your Name:

Title:

Estimated Customer Base / Patrons Per Day /
Rounds Played Per Year / Club Members / Etc.
(Specify number per time period):