BDANENY Membership Interest
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The Bleeding Disorders Association of Northeastern New York would like your input about which quality programs you would be interested in attending.
Please take just a few minutes to respond to this survey.
1
. If a free educational offering were available for the bleeding disorder community would you be interested in attending?
If a free educational offering were available for the bleeding disorder community would you be interested in attending?
Yes
No, if no please go to the end of this survey and press "done." Thank you for your response.
2
. If you answered yes, please click on all topics that would interest you.
If you answered yes, please click on all topics that would interest you.
Living With Hemophilia
Living with an Inhibitor
Managing the cost of Hemophilia
Joint Health
Teenagers; Understanding and Living with Their Bleeding Disorder
Women and Bleeding Disorders
School Issues
Special Concerns for the Aging
From Bloody Nose to a Bleeding Disorder, After the Diagnosis
Strategies for the Caregiver
Other (please specify)
3
. Would you be more likely to attend during
Would you be more likely to attend during
the weekend?
the week?
the day doesn't matter.
4
. What time of the day works best for you?
What time of the day works best for you?
Morning
Noon
Afternoon
Evening
5
. If we are to have an educational event would you want to
If we are to have an educational event would you want to
have a full meal included?
have an informal pizza/and or ice cream discussion?
have snacks and beverages?
Other (please specify)
6
. We would like to know more about where you are located. The following question is optional but it would help us to pick the best location to hold a program.
We would like to know more about where you are located. The following question is optional but it would help us to pick the best location to hold a program.
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
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