Tell us about your visit to Cobb Theatres

1.	What movie theatre did you visit?
	--Click Here-- Dolphin 19 Miami Lakes 17 Hialeah Grand 18 Downtown at the Gardens 16 Jupiter 18 Merritt Island 16 Lakeside 18 Grand 10 Grove16 Hollywood 16 Pinnacle 14 Jasper 4

2.	Please enter the date and time of your visit
	Date of visit
	Time of visit

3.	How often, on average, do you visit the theatre?
	--Click Here-- Once a Week Twice a week Twice a Month Monthly

4.	How many people were in your party today?
	Adults
	Children

5.	How much did you spend in total on Concession items?
	--Click Here-- $0.00 $1.00 - 10.00 $11.00 - 20.00 $21.00 - 30.00 $31.00 +

6.	How do you rate the following?
		Very Good		Good		Poor		Very poor		Don't know
	Speed of Service
	Cleanliness
	Friendliness of Staff
	Quality of food
	Overall experience

7.	Are there any other comments that you would like to make?

Tell us about yourself

8.	What is your age?
	--Click Here-- Under 18 18-24 25-34 35-44 45-54 55+

9.	Male/Female?
	--Click Here-- Male Female

10.	Household Income Range
	--Click Here-- Under $25,000 $25,000 - $35,000 $35,001 - $55,000 $55,001 - $75,000 $75,001 - $100,000 Over $100,000

11.	Please enter your zipcode/postcode.

12.	Please enter your email address for a random drawing once a month for 2 Free Movie Tickets.