Intake form

Name *

Email address *

What is your primary reason for visiting qerimox?

What type of community activities are you interested in?

Please select at least one option.

Art Exhibitions

Music Events

Educational Workshops

Networking Sessions

Fitness Classes

Food and Drink Tastings

Please specify your preferred method of contact.

Please select at least one option.

Email

Phone

In-person Meeting

What days of the week are you typically available to attend events?

Please select at least one option.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What time of day do you prefer for events?

Please select at least one option.

Morning

Afternoon

Evening

No Preference

Do you have any specific ideas or suggestions for community activities?

Additional questions or comments