What is your name?
E-mail address?
Do you want your e-mail address published so people can contact you with questions?
YesNo
Do you want your name published
or would you rather remain anonymous?
Yes,
please use my name Could
you just put anonymous?
Are you a member of Alamo Celiac (for our
information, not to be published with your answers)?
No,
I am not a member of Alamo Celiac in Austin
Yes,
I am a member of Alamo Celiac in Austin
If no, would you please tell us (for our
information)?
I was just visiting Austin
I am a member of
different chapter of Alamo Celiac
I live in Austin but haven't joined Alamo Celiac
Name of Restaurant:
When Did You Eat There Last:
Type of Food:
Other??
Use the box below to specify.
If you did not get a
business card with an address while you were at the restaurant to help you fill
in the address below, try looking the restaurant up at one of these helpful
sites: AnyWho.com, Austin
Chronicle or Austin360.com.
You
are more likely to recognize the street address than I am if I look it up and
try and guess a location. THANKS!
Address (line 1):
Address (line 2):
If the restaurant has other locations in town that you would like to tell us
about please put them in the field at the bottom.
Part of Town:
Phone Number:
and 
Entrees run about:
Under $10
(¢) $11 - $20
($) $21 - $30
($$) $31 - $40
($$$) over $40
($$$$)
Recommended Items:
Comments:
Other Locations?
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