MUFL Action: Surveys


Mask Discrimination Survey

Question 1: Name?

Question 2: City / Town?

Question 3: State?

Question 4: Zip code?

Question 5: E-mail Address?

Question 6: Phone number?

Question 7: What is the name AND location of the business that denied your service or entry? *DUE TO THE VOLUME OF RESPONSES, WE CANNOT ADD BUSINESSES TO THE NAUGHTY LIST IF THE NAME AND CITY IS NOT PROVIDED.

Question 8: Approximate date and time of incident?

Question 9: Do you have a medical condition which prevents you from being able to medically tolerate the wearing of a mask?

Rather not say

Question 10: Please provide any additional information about the situation which may be helpful.