First Name

Last Name

Name I prefer to be called

Address(street, #, apt. #)

City

Zip Code

Home Phone

Work Phone

Mobile or Pager

e-mail address

hometown

Best recent film (since January 1)

Worst recent film (since January 1)

Top ten favorite films

T hree favorite directors

Best recent book

Favorite book

Where do you work / go to school?

If you work, what do you do?

Film & digitial interests...