Museum Membership Survey

Membership Survey

Please fill out this survey to help us better serve you.
Receive a 1-year General Membership for your participation (a $50 value), unlimited access to the online Docu-Tour during your membership year and one (1) invitation to attend the Grand Opening Ceremony of the expanded Museum (Date TBA).

You will also receive the chance to receive one of ten, $100 gift cards. All questions must be filled out.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Demographic Information
Age *

0 - 17 18 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 or more
Ethnicity *

White Asian American Indian Black or African American Middle Eastern or North African Hispanic Latino or Spanish origin Native Hawaiian or Other Pacific Islander Other
Gender *
Education *

Less than HS diploma High school Some college Bachelors degree Graduate degree Higher education
Current Employment *

Student Unemployed (looking for a job) Unemployed (not looking for a job) Self-employed Full-time employment Part-time employment Retired
Household Income *

$0 - $24,999 $25,000 - $49,999 $50,000 - $74,999 $75,000 - $99,999 $100,000 - $149,999 $150,000 or more
Marital Status *

Single Married Divorced Widowed
Are you the descendant of a Pullman Porter? *

Yes No
The Museum
Have you ever visited the A. Philip Randolph Pullman Porter Museum? *

Yes No
What children's activities do you want to see from the Museum? *
If you were in charge, what changes would you make to the Museum? This could be programming, exhibits, online or offline suggestions. *
What is your favorite part of the A. Philip Randolph Pullman Porter Museum? *
May we contact you to discuss your answers? *

Yes No
Final Questions
Would you like to join our mailing list? *

Yes No
Your support helps us continue our legacy. Would you like to make a donation to the Museum? *

Yes No
Donation Amount

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USD Description
Is there anything else you would like us to know?
Should be Empty:

Membership Survey

Demographic Information

The Museum

Final Questions