MEMBER SURVEY - Us TOO Rochester NY
All attendees of Us TOO Rochester NY meetings -especially members- are encouraged to take this survey. It can be completed in less than 5 minutes. When finished, click on the SUBMIT button below. At that time any incomplete items will be highlighted for your attention. Most items are 'required', but items requesting contact information are 'OPTIONAL'. Thank you for helping Us TOO Rochester NY to serve you better. -- Patrick Fisher [Project Mgr.]
In a few words, please tell us if the meeting you attended was helpful, OR how we can improve meetings to better serve your interests. *
Your answer
Where is your geographic location? *
Choose one.
Do you have transportation? *
Choose one.
How many miles would you be willing to travel to attend a meeting or lecture of concern? *
Choose one.
How often would you attend a meeting with Us TOO? *
Choose one.
If you were the Leader, who would you invite to attend meetings? *
Choose the audience you would pick if it were up to you.
Which audience are you most comfortable with when discussing erectile dysfunction? *
Choose one.
First name:
Your answer
Last name:
Your answer
Address:
Your answer
City: *
Your answer
State:
Your answer
ZIP: *
Your answer
Preferred phone: *
For example: 585-555-1212
Your answer
Preferred Email address:
Your answer
May we contact you? *
What is your preferred method of contact? *
Indicate the one you check most frequently.
Select the ONE item that best describes why you attend meetings. *
If 'Other', please briefly explain.
Select the ONE statement that best describes your status or diagnosis:
If 'Other', please briefly explain.
If you are a survivor, what year were you diagosed with prostate cancer?
Your answer
How many hours does your schedule allow you to volunteer helping Us TOO Rochester NY? *
Select the ONE statement that best describes you at this time.
How would you like to be notified about meetings? *
Choose one.
May we send you the monthly Us TOO Newsletter? *
How would you like to receive the newsletter? *
Choose one.
In what ways can you help Us TOO Rochester NY succeed? *
Select 3 statement(s) that reflect how you would like to help.
Required
What topic related to your condition would you or your loved one like to learn more about? *
Your answer
What topic NOT-related to your condition would you or your loved one like to learn more about? *
Your answer
Would you like a staff person from Us TOO Rochester NY to call you by phone to discuss things privately? *
Successful organizations use a 'logo' on their stationary letterheads, websites, business cards and other communications. The 'logo' eventually becomes known by the community it represents. *
Help us determine what an effective 'logo' should look like for our Chapter of Us TOO International Inc, now called: Us TOO Rochester NY.
Suggest ways you feel we could raise funds while spreading the word about our organization? *
Base your answer on ease of executing, target audiences, OR amount of potential funds to be raised.
Your answer
Please identify any limitations we should consider on your behalf when planning meetings or events? *
For example: any hearing or sight conditions, stairs etc.
READ THIS BEFORE YOU CLICK THE 'SUBMIT'.BUTTON... and, thank you for taking time to share your responses. *
After you click 'Submit', a new page will appear. Scroll to the TOP of the NEXT screen to see your confirmation. Then you can 'close' the window OR return to our Home Page.
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