ILAIMH Membership Survey

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1. Are you a member (2010) of the Illinois Association of Infant Mental Health?

Are you a member (2010) of the Illinois Association of Infant Mental Health? Yes	No
If not, is there a particular reason why you are not a member?

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2. Which of the following ILAIMH activities have you participated in the past 2 years, please check all that apply

Which of the following ILAIMH activities have you participated in the past 2 years, please check all that apply Annual Conference

Spring Seminar Series

posted a message or a response to the ILAIMH listserv

Credential committee

Brown bag

Study group

ILAIMH committee

3. What would you like from your membership that is not currently being offered?

What would you like from your membership that is not currently being offered?

4. Would you be interested in joining any of the following? Check all that apply

Would you be interested in joining any of the following? Check all that apply study group or book group

Peer support/supervision

Becoming a “fan” of ILAIMH on Facebook

networking consortium

a social networking dinner

meet & greet

Meetings

blogs

chat rooms

brown bag

breakfast meet-up

Other (please specify)

5. What time of day would you be most interested in meeting for a ILAIMH activity, (i.e study group, Supervision group, etc)? Check all that apply

What time of day would you be most interested in meeting for a ILAIMH activity, (i.e study group, Supervision group, etc)? Check all that apply Early Morning (7-10am)

Mid morning (10-12)

Mid Afternoon (12-2pm)

Late afternoon (2-4)

Just post-work (4-6)

Evening (6-8)

Weekends

6. How far would you be willing to travel? Please answer in miles.

How far would you be willing to travel? Please answer in miles.

7. If you are interested in participating in a group OR if you are interested in participating in the raffle, please check one of the boxes.

If you are interested in participating in a group OR if you are interested in participating in the raffle, please check one of the boxes. Group

Raffle

Both Group and Raffle

8. If you checked any of the boxes in 7 please include your email address below in the space below.
If you are ONLY interested in the raffle, your email address will only be stored until the raffle is over
If you are interested in participating in a group, please also include your name as well as your email address. We will contact you in the near future with more information

If you checked any of the boxes in 7 please include your email address below in the space below. *If you are ONLY interested in the raffle, your email address will only be stored until the raffle is over *If you are interested in participating in a group, please also include your name as well as your email address. We will contact you in the near future with more information

9. What is your zip code. Providing this information will help us better understand member interests by region of the state.

What is your zip code. Providing this information will help us better understand member interests by region of the state.

10. We would like to hear from you! Please include any thoughts, ideas and/or comments about the Illinois Association of Infant Mental Health (positive or negative)that can better help us to serve you.

We would like to hear from you! Please include any thoughts, ideas and/or comments about the Illinois Association of Infant Mental Health (positive or negative)that can better help us to serve you.

ILAIMH Membership Survey
Exit this survey

1. Default Section

*
1. Are you a member (2010) of the Illinois Association of Infant Mental Health?

*
2. Which of the following ILAIMH activities have you participated in the past 2 years, please check all that apply

3. What would you like from your membership that is not currently being offered?

4. Would you be interested in joining any of the following? Check all that apply

5. What time of day would you be most interested in meeting for a ILAIMH activity, (i.e study group, Supervision group, etc)? Check all that apply

6. How far would you be willing to travel? Please answer in miles.

7. If you are interested in participating in a group OR if you are interested in participating in the raffle, please check one of the boxes.

9. What is your zip code. Providing this information will help us better understand member interests by region of the state.

10. We would like to hear from you! Please include any thoughts, ideas and/or comments about the Illinois Association of Infant Mental Health (positive or negative)that can better help us to serve you.

ILAIMH Membership SurveyExit this survey

1. Default Section

*1. Are you a member (2010) of the Illinois Association of Infant Mental Health?

*2. Which of the following ILAIMH activities have you participated in the past 2 years, please check all that apply

3. What would you like from your membership that is not currently being offered?

4. Would you be interested in joining any of the following? Check all that apply

5. What time of day would you be most interested in meeting for a ILAIMH activity, (i.e study group, Supervision group, etc)? Check all that apply

6. How far would you be willing to travel? Please answer in miles.

7. If you are interested in participating in a group OR if you are interested in participating in the raffle, please check one of the boxes.

9. What is your zip code. Providing this information will help us better understand member interests by region of the state.

10. We would like to hear from you! Please include any thoughts, ideas and/or comments about the Illinois Association of Infant Mental Health (positive or negative)that can better help us to serve you.

ILAIMH Membership Survey
Exit this survey

*
1. Are you a member (2010) of the Illinois Association of Infant Mental Health?

*
2. Which of the following ILAIMH activities have you participated in the past 2 years, please check all that apply