Vliet Museum Web Visitor Survey 
What brings you to the Vliet Museum Web site?
Have you visited this site before?
Yes - Number of times:
No
What is your connection to Lake Bluff and to the Vliet Museum? (check all that apply)
 Live(d) in Lake Bluff from
 to
 Conducting Research
 Relatives live(d) here from
 to
 Work in Lake Bluff area
 Friends live(d) here from
 to
 Other
Have you participated in any Vliet sponsored events?
If yes check all that apply.
 Ghost Walk
 House Walk
 Time Travelers
 School Programs
 Presentations
 Other
Do you have a story to share about Lake Bluff's past? If yes, please provide details.
First Name
Last Name
Email Address
Address 1
Phone 1
() - x
Phone 1 Type
Address 2
Phone 2
() - x
Phone 2 Type
City
State
Zip
Please add me to the Vliet mailing list.
  Commemorative Brick Order  
(for donations of $100 or more)
I/we would like to order a commemorative brick, the net proceeds of which will be divided equally between the Vliet Center and Friends of the Library.

Your commemorative brick will be imprinted with your message and installed in a special area outside the Vliet Museum. Please use the lines provided below for your message. Print the message in capital letters, exactly how you want it to appear on the brick. There is a limit of 3 lines per brick, with a maximum of 13 characters per line.
Line 1
Line 2
Line 3
First Name
Last Name
Email Address
Address 1
Phone 1
() - x
Phone 1 Type
Address 2
Phone 2
() - x
Phone 2 Type
City
State
Zip
Please add me to the Vliet mailing list.
Please accept my/our donation of: $ ($100 minimum for a commemorative brick)
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