Please help us as we form this new chapter to enable us to best serve your needs by filling out the following survey:
1) What are your top 3 needs/information focus, right now? (Check 3)
Other:
2) What support groups would you like to participate in or see formed? (Check all that apply.)
Other:
3) What speakers/topics would you like to see presented at a meeting?
4) Would you like interested in helping on a committee or facilitating a support group?
If so, what would you be interested in doing?
5) How would you like our Chapter to be of assistance to you?
6) Please tell us a little about yourself:
Name:
Phone:
Email:
ASA/ASW member?
Is it OK to contact you?
Thank you for participating in our survey!
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