Family Food Survey

If you're in the Cowichan Valley and would like to be supplied with delicious natural foods from May to September in 2009, please fill out our survey to let us know the kinds of yummy naturally-grown pesticide-free food you'd like to receive.

Your Name *

Phone Number *

Email Address *

Family Size

   1 2 3 4 5 6 7 8 9 10  Adults

   1 2 3 4 5 6 7 8 9 10  Children

Meats

Please indicate the types of meats your family consumes and the approximate frequency :

Chicken  

   Once a month Twice a month Once a week Twice a week

Beef

   Once a month Twice a month Once a week Twice a week

Pork 

   Once a month Twice a month Once a week Twice a week

Lamb  

   Once a month Twice a month Once a week Twice a week

Produce

Please indicate which of the following types of produce your family likes to eat :

Potatoes

Carrots

Peas

Beans

Spagetti Squash

Acorn Squash  

Tomatoes

Turnips  

Comments & Questions?

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