Questionnaire

Your Information:
Your full name:
Your phone number:
Your e-mail address:
Street Address:
City: State: Zip Code:
Recipent's Information:
Full name of person to be portrayed:
Boy or girl, man or woman? Gender:
By what name do most people address him/her?
Does he/she have a nickname?
If so, please indicate the nickname:
Age of person to be portrayed (if relevant):
Date of the Birthday, Anniversary, Retirement
or other event that is being celebrated:


Important Note: Each of the following fields is optional. Please feel free to ignore any of the fields if the field is irrelevant or inappropriate. Remember, however, that the more specifics you give us, the more specific we can be in creating the finished product.
Also Note: Not every piece of information you give us will necessarily fit into the song. Please place an exclamation point (!) after entries that are particularly important.

Family members' names (mom, dad, siblings, aunts, uncles, grandparents):

How does he/she address parents (e.g., Mom, Dad, Mommy, Daddy, Mother, Father, etc.)?

How does he/she address grandparents (e.g., Grammy, Poppy, Grandma, Grandpa, Nana, Poppa, etc.)?

Names of closest friends and any relevant information regarding each friend:

Names of boss(es), co-worker(s) and any relevant information regarding each person:

What are his/her favorite activities (e.g., swimming, soccer, chess, playing music, painting, reading, etc.)?
Please add as many as you like and be as specific as possible.

Is there anything else specific that you want included in the lyrics of the song? (e.g., incident(s), favorite animal,
favorite place, favorite sports team(s), favorite band(s) and singer(s), writer, painter, favorite teacher(s) or mentor(s), movies,
obsessions, pet peeves, food, security blanket, pet(s), etc.) Please add as many particulars as you like and be as specific as possible.

Please list any and all taboo subjects and references that we should avoid (i.e., politics, religion, sexual preferences,
marital status). We absolutely do not want to offend or embarrass anyone.

What styles of music does he/she like to listen to and/or play?

Do you prefer a male or female voice to perform the song?
Male
Female
No preference

Which song option would you like to choose as the basis for your song?

Additional information (please feel free to elaborate extensively):

Will you be sending us photographs that we can incorporate into the packing of your musical portrait?
(Note: Be sure to send us COPIES, not originals.) If "yes", please identify the most important picture(s) by specifying somewhere
on the back of the photo(s). If you send them to us as attachments to e-mails (preferred), please indicate if any are more
important than the others for us to possibly include in the packaging.
Yes
No

Will you be sending us any digital audio files (e.g., recordings of the honoreeís voice that we can incorporate
into the song)? If so, please identify whose voice is on the recording and, if possible, the nature of the recording or any other
relevant information. This is completely optional. Also, please send us just a few minutes of recorded sound. If we do incorporate
any of the recorded voice, we will use at most a segment or two of only a few seconds in length. We wonít be able to wade through a
long recording in search of suitable sounds. (Note: Be sure to send us COPIES, not originals.)
Yes
No

Feel free to add any other relevant information below: