Address:
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Zip Code:
Email Address:
Gender:	Please Choose Male Female

Age Range:	20-25	26-30	31-35	36-40	41-50
		51-60	61-and then some

How did you hear about us?

Qualifications

Education (check all that apply):
	Culinary School
	Restaurant Management School
	Apprenticeship Program
	School of Hard Knocks. Want to see the bruises?
	Other (explain)
Restaurant Experience Level (check one):
	Worked in a restaurant 1-5 years
	Worked in a restaurant 6-10 years
	Worked in a restaurant 11-20 years
	Worked in a restaurant 20+ years
	Have just eaten in restaurants
Area of Expertise (check all that apply):
	Chef
	Wait Staff
	Line Cook
	Owner/Operator
	FOH Manager
	Bus Staff
	Other (please specify)
Vision  Overall (check all that apply):
	Change the food world
	Make a ton of money
	Have a ton of fun
	Just serve great food
Type of restaurant (check all that apply):
	Full service (white tablecloth)
	Full service (casual)
	Carryout/Take-out
What cuisine would you like to do:
	Please fill in
Service preference (check all that apply):
	Breakfast   Lunch   Dinner
Size of restaurant:
	Neighborhood (40-80 seats)
	Mid-sized (80-150 seats)
	Jumbo-sized (150+ seats)
Growth Expectation:
	One-off
	Multi-unit
	Franchise
Stage in the process (check one):
	Still thinking about it, but want help
	Have backers in mind; haven't approached them yet, but need advice
	Raised money but don't know what to do next, and need advice
	Money in the bank, found a place, but need some help
	Found a place; don't yet have the money, but want some help
	Already have one place looking to do it again, and need some help
Expect to spend to open up the restaurant:
	$100K $100-500K $500-1M $1-5M $5M+
What time commitment do you plan to devote to the new restaurant:
	I want to have a life outside of my restaurant (40 hours)
	I want to be somewhat hands-on in the business; but I need weekends and holidays off (60 hours)
	I am very hands-on and don't mind working weekends (80 hours)
	24 x 7 is okay with me; this IS my life (80+hours)
Preferences Where do you want to locate the restaurant:
	City State
Computer Literacy (check one):
	My little cousin helps me turn the machine on (little or no experience)
	Use the computer for some restaurant functions and email but that's it (some experience)
	My copy of "Hackers Weekly" is well worn (lots of experience)
Role Models (who do you most identify with, who do you think has done the most for the industry, favorite chefs, favorite owners, etc.):
Hobbies/Interests (in your off time):
Emotional readiness:
	I like risk
	I'm scared of the dark
	I cry at sad movies