PERC Community Connection Form
Are you a member of PERC?
Yes - my membership is current
No - but I used to be
I don't contribute financially, but I volunteer.
I'm not sure
How do you get the PEN? (Check all the apply)
In the mail - I'm a suscriber
I pick it up at my local library or community centre
I pick it up from another location (business, place of worship, etc.)
A family member or friend shares it with me.
At events where PERC is represented.
Where would you like to see the PEN distributed? (check all that apply)
More coffeeshops/small businesses
My place of worship
My doctor/dentist office
Can you share some details about the places you selected? (If you only know the name, that is fine!)
Would you be interested in picking up a stack of PENs to bring to one or more of the places you listed?
Yes! (leave contact info in "Other")
I'm not sure - tell me more about how it works? (leave contact info in "Other")
No, I'm not able to.
Do you know anyone else who is interested in the topics covered in the PEN? (check all that apply)
Yes - all of them
Yes - especially environmental issues
Yes - especially Peace & Social Justice issues
I'm not sure but I'll think about it
What would be the best way to reach out to them?
I'll mention it to them!
Can PERC please contact them? (Fill in Info in next question)
I'd like to leave them a copy - please send me some extras! (Leave address in next question)
Not sure - I'll think about it.
Please fill in any relevant names or contact information from the previous question.
Do you know anyone who might be interested in writing or editing for the PEN?
Yes, and I'll give their contact information in the next question.
Yes, and I'll reach out to them myself.
Maybe - can I find out more?
No, but I'll keep an eye out.
Please list any relevant contact information from the previous question.
Can you suggest any local businesses you think should advertise in the PEN? Please list as many as you want.
Are there other groups or organizations you think PERC should connect with? Please list as many as you want.
Any other thoughts or comments?
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