Name:  *

E-Mail Address:*

1.  Would you ever donate money to America's Soup Kitchen?*         Yes No

2.  If so, how much would you consider donating?*       Please select an amount from this list: $0-10 $10-50 $50-100 $100-1000 $1000+

3.  On a scale of 1-10, how effective do you think our mission will be based on what you've seen so far?*

  Please select a number from the list: 1-Impossible 2 3 4 5-No decision 6 7 8 9 10-Will happen/Highly likely

4.  Please state any other suggestions here: