Playlist Questionnaire

* These items are required.

If you would prefer to fill out a paper form, click here to download.

Listener information

Name *

Age

High school graduation year

Telephone number *

Caregiver information

Name *

Telephone number *

Library barcode number (Listener or Caregiver) *

Listener's Music Preferences

Favorite type(s) of music
BluesBig BandsClassicalCountry/Western*JazzLatinoOldiesOperaR&BRock & Roll*ReligiousShow Tunes*Other*

*Oldies Decade 40s50s60s70s

*Please be specific


What songs did you dance to at your wedding or prom?

When you were young, who/what were your favorite singers/performers (list 5-10)?

Favorite hymns or other religious music:

Anything else important (other likes/dislikes, etc.), or any other specific music requests:

COMSEWOGUE PUBLIC LIBRARY
170 Terryville Road
Port Jefferson Station, NY 11776

COMSEWOGUE PUBLIC LIBRARY
170 Terryville Road
Port Jefferson Station, NY 11776

HOURS
Monday-Thursday 9:30 am - 9 pm
Friday-Saturday 9:30 am - 5 pm
Sunday 12 pm - 4 pm

HOURS
Monday-Thursday 9:30 am - 9 pm
Friday-Saturday 9:30 am - 5 pm
Sunday 12 pm - 4 pm

CONTACT
Phone (631) 928-1212
Fax (631) 928-6307

CONTACT
Phone (631) 928-1212
Fax (631) 928-6307