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Bedworth Customer Feedback Form
Customer Feedback
Title
Mr
Mrs
Miss
Ms
Forname(s)
Surname
Address
Postcode
Telephone Number
Email
Your Comments/Suggestions
Age Group
Up to 16yrs
17-24yrs
25-49yrs
50+yrs
Date of Visit
Time of Visit
Frequency of Visit
Once a week
More than once a week
Occasional
First time
Do you wish to recieve leisure information
Yes
No