Entertainment Survey

Take our survey and get up-to-the-minute entertainment news, entertainment information, entertainment offers and more. Stay on top of entertainment trends, receive special offers tailored to your interests and learn about new products and services with Electronic-Confirmation.


It's important to supply accurate and complete information. All fields with asterisks are required.
First Name: *
Last Name: *
E-mail Address: *
Street Address:
Zip/Postal Code:
Mobile Phone:
Mobile Carrier:
Other Carrier:


Demographic Information:

Date of Birth:
Marital Status:


Entertainment Information

How often do you eat out?
What types of restaurants do you eat at most?
What is your favorite type of restaurant to eat at?
Do you like to go to the movies?
Do you like to go to concerts?
Do you like to go to museums?
Do you attend sporting events?
Do you like to go to the theater?
Do you like to go to amusement parks?

I would like to receive additional information from third party advertisers related to my above interests.
Yes No


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