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*Date: mm/dd/yy

*First Name:
*Last Name:
Email Address:

*Mailing Address:
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*City:   *State:    
*Country:     *ZIP:
Permanent Address? Yes No

Would you like to receive a Beatty, Nevada Visitor Information Packet? Yes No

Would you like to receive Relocation Information about Beatty? Yes No

Would you Like to Receive information about future events in and around Beatty?
Yes, please send event info by email
Yes, please send event information by standard mail
No

Thank you for your interest in Beatty, Nevada. Our wish is to serve you in the best way we can. To help us serve you better, please fill out the following visitor interest survey.

Dates you plan to visit the area:
Number of days planned in the Beatty area

Is this your first Visit to the Beatty, Nevada area? Yes No

Number in your household: Adults 18-25 26-35 36-45                         46-55 56-65 66-75 Over 75   
Children Under 6 6-12 13-17  
Pets    Live Stock   

How many persons will be in your traveling party?

What is the primary reason for the trip you are planning: Choose one or more Vacation Community Event Family Event Business Relocation Other Other
For multiple Choices, hold down the "Ctrl" key while making choices.

Is there a secondary reason for the trip you are planning:
Yes No Choose one or more Vacation Community Event Family Event Business Relocation Other
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What form(s) of transportation will you use on your trip? Choose one or more Personal Car Rental Car 4 Wheel Drive Motorcycle Bicycle Motor Home Off Road Vehicles Hiking
For multiple Choices, hold down the "Ctrl" key while making choices.

Which Types of activities are you likely to participate in on your trip? Choose one or more Visit Death Valley Visit local Attractions Outdoor Recreation Play Golf Watch Sports Play Sports Dining Nature Activities Night Life Casino Gaming Heritage/Cultural Activities Shopping Sight Seeing Photography Other Arts Live Theater Visit Friends & Family Festivals
For multiple Choices, hold down the "Ctrl" key while making choices.

Employed? Yes No
Retired? Yes   No

Occupation of primary wage earner Please Select One Banking Construction Farming/Ranching Government Employee Homemaker Retired Military Student Hospitality Gaming Student Service Other
Occupation of secondary wage earner Please Select One Banking Construction Farming/Ranching Government Employee Homemaker Retired Military Student Hospitality Gaming Student Service Other

Please tel us how your heard about Beatty, Nevada
Check all appropriate boxes:
Personal Experience
I heard about Beatty from a friend or Relative
I have seen Beatty adds in: Please Choose one or more Nevada Magazine Nevada Open Roads RV Journal Newspaper Ad
I found you on the Internet
I discovered Beatty while traveling
I read about Beatty in a travel guide/article
Other:
Please tell us how you heard about Beatty

Comments or Special Requests
Do you have special needs for your trip, or want special information about the area?