2. Lenawee County Health Department - Movie Theater Ad Survey
4. First Name
5. Last Name
7. Have you been to the Adrian Cinema to see a movie since January 1, 2019? *

   1. Yes
   2. No
9. Did you see any of our immunization advertisements? They run on the screen immediately before the previews.

   1. Yes
   2. No
11. Which advertisement did you see? Check all that apply.

    1. Adult
    2. Adolescent
    3. Not Sure
13. Thank you!
    For more information about the health department's immunization program, visit: http://www.lenawee.mi.us/233/Immunization
Leave This Blank:


15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

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