Women's Initiative Education Kit Survey

Thank you for viewing the Women's Initiative Education Kit. We hope you found the information helpful. We very much appreciate your commitment to supporting a healthy and safe community.
In order to help our mission to reduce prescription drug abuse, please answer the following questions regarding your experience with the Women's Initiative Education Kit. This short survey should take less than 10 minutes to complete.
The asterisks (*) designate questions that require answers.

Question Title

* 1. Please enter your contact information.

Question Title

* 2. What is your age range?

Question Title

* 3. What is your gender?

Question Title

* 4. What date was your Viewing Party held?

Question Title

* 5. Was the Viewing Party work related or was it a social gathering?

Question Title

* 6. In what zip code was the Viewing Party held?

Question Title

* 7. How many people attended your Viewing Party?

Question Title

* 8. How many copies of the Education Kit did you hand out?

Question Title

* 9. How many Pledge Cards did you receive back?

Question Title

* 10. What was the general reaction of your guests? What were the most common comments?

Question Title

* 11. Do you have any suggestions for others who may be hosting a Viewing Party in the near future, or other comments?

Question Title

Thank you for your continued support and committment to preventing prescription drug abuse in our community.

Thank you for your continued support and committment to preventing prescription drug abuse in our community.

T