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1-800-879-7483

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First Name:
Last Name:
Address 1:
Address 2:
City:
State/Zip:
Phone:
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1. How did you first find this Web Site?
Rivers Promotional Material
Print Advertising
Radio Advertising
Yahoo
AOL
Alta Vista
Other Search Engine
Other, specify:

2. Have you ever been whitewater rafting?
Yes
No
If yes, how many times?
1-5
5-10
10+

3. Have you ever been whitewater rafting in West Virginia?
Yes
No
If yes, how many times?
1-5
5-10
10+

4. What year were you born?
(mm/dd/yyyy)

5. Your gender & marital status, please?
Male/Single
Male/Married
Female/Single
Female/Married

6. How many adventure enthusiasts live in your household?
1
2
3
4
5+

7. How many times per year do you travel for vacation/pleasure?
1
2
3
4
5+

8. How would you rate your visit to Rivers' Web Site?
Excellent
Good
Fair
Poor

9. What is your occupation?
Management
Labor
Medicine
Technical/Industrial
Government
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Marketing/Sales
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Other

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1-800-TRY-RIVERS 1-800-879-7483

Register to Win a Free Raft Trip with Rivers!

1-800-TRY-RIVERS
1-800-879-7483