Feedback Form

Musical Performance Feedback Form
Please complete this form for each Creative Aging Mid-South musical performance held at your facility.

* indicates required fields

*Facility Name::

*Performers' Name(s)::

*Perfomance date:

*Perfomance time:

*Total # of people attending:

*Number of people who are 65+ years old:

*Number of men in audience who are 65+ years old:

*Please rate the overall performance:

*Please rate artists' interaction with the audience:

1 -- There was none
2 -- Some after the performance
3 -- Some during the performance
4 -- Some during and after the performance

*Did the artist contact you before the performance?:

Yes
No

*Was the music too soft or too loud?:

too soft
just right
too loud

*Will schedule these performers again?:

Never
Possibly
Definitely
Anytime I can

What did you like about the performance?:

Comments:

Thank you for completing this form. We use your feedback to ensure that we continue presenting artists that our audiences enjoy.

with support from:

The H. W. Durham Foundation

200 Jefferson Ave. Ste. 707 Memphis, TN 38103 (ph) 901.272.3434 (fax) 901.274.8369 creativeaging@bellsouth.net

Creative Aging Mid-South is tax-exempt
under section 501(c)(3) of the Internal Revenue Code.