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Salutation:
Mr.
Ms.
First Name:
Last Name:
E-mail:
Day Time Zip:
Night Time Zip:
Have you ever been to Cereality before?
Yes
No
If you have been to Cereality before, what did you purchase?
(
check as many as apply
)
Cereality Cold Cereal Blend "Our Way"
Cereality Cold Bowl "Your Way"
Cereality Hot Cereal Blend "Our Way"
Cereality Hot Bowl "Your Way"
Slurreality
Cereality Parfait
Cereality Snack Bar
Cereality Bites Snack Mix
Hot Beverage
Cold Beverage
Cereality Gift Card
Cereality Branded Merchandise
(baseball cap, pajamas, mug, etc.)
I did not purchase anything
Other (Please describe below)
Describe Yourself
Describe Yourself
Student - Undergraduate
Student - Grad/Med/Law etc
University Faculty
University Staff
UC Area Resident
Work in UC Area
Other
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