Full Name
*
First Name
Last Name
E-mail
*
Your Town / Village:
*
Day of visit:
*
Please Select
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time of visit:
*
Please Select
Morning
Lunch
Dinner
Let us know how we did today:
Please rate the following (1 = Poor, 5 = Excellent):
*
1
2
3
4
5
Atmosphere
Welcome
Menu Choice
Food Quality
Service
Value
How did you hear about The George at Burpham?
*
George at Burpham e-letter
Recommended by others
Longstanding customer
Online Pub Guide
Saw the A27 Sign
Tripadvisor
Facebook
Newspaper
Magazine
Walking
Google
Other
Enter the message as it's shown - prove you're not a robot!
*
Submit
Should be Empty: