Ambassador Feedback Form

Name*
Program Date*
Community
Program / Artist(s)
Approximate number in the audience
Please rate the overall program by selecting the appropriate number, using the following scale.	1 (Poor) 2 3 4 5 (So-So) 6 7 8 9 10 (Excellent)
The performance was (check all that apply) :	Outstanding Uplifting Enjoyable Engaging Mediocre Too mellow Inappropriate
The artist interacted with the audience (check all that apply):	Before the performance During the performance After the performance
Taking into consideration the overall health of the audience, the audience's level of engagement with the artist / performance was (check all that apply):	Somewhat engaged Engaged Very engaged
Please share a comment from the audience or special story that happened during the performance.
Do you have any suggestions to improve the program / performance or Creative Aging Services?

Please answer the simple math question below to submit the form.

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Enriching Lives Through the Arts

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Contact

2029 Peabody Ave. | Memphis, TN 38104

Program Requests: 901.272-3434

General Information: 901.272.3434

mhenley@creativeagingmidsouth.org

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