Full Name: 

Address1:  

Address2:  

City:  State:   Zip:

Email address: 

Phone: 

Fax:

Type of wine most enjoyed:  Select One White Red Blush

Particular Country? 

Particular Style? 

Particular Winery? 

Do you Enjoy Primarily With Food? Yes No

Do you keep wine on hand in your home?  Yes No

Do you have an interest in formal wine tasting? Yes No

Would you like a wine tasting in your home?  Yes No

How did you hear about us? Select One Flyer Newspaper Advertisement Word of Mouth Yellow Pages Email Web Site Other

If "Other" please specify.

Have you been to Signature By The Lake?  Yes No

If Yes, what was the event or occasion?

Do you have an interest in cooking classes? Yes No

Do you entertain in your home?  Yes No

Are you interested with matching wine with food? Yes No

What is your favorite style of food? 

Would you like to continue receiving this newsletter? Yes No

Please list the Email addresses of anyone you know who would like to receive this newsletter: