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* 1. Name

First Name:

Last Name:

Email Address:

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* 2. My Specialty is:

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* 3. Please rate the items listed below:

	Excellent	Good	Satisfactory	Poor
Activity met my needs	Activity met my needs Excellent	Activity met my needs Good	Activity met my needs Satisfactory	Activity met my needs Poor
Activity made me want to learn more	Activity made me want to learn more Excellent	Activity made me want to learn more Good	Activity made me want to learn more Satisfactory	Activity made me want to learn more Poor
Activity valuable to me professionally	Activity valuable to me professionally Excellent	Activity valuable to me professionally Good	Activity valuable to me professionally Satisfactory	Activity valuable to me professionally Poor
Format facilitated learning	Format facilitated learning Excellent	Format facilitated learning Good	Format facilitated learning Satisfactory	Format facilitated learning Poor
Opportunity for participation was	Opportunity for participation was Excellent	Opportunity for participation was Good	Opportunity for participation was Satisfactory	Opportunity for participation was Poor
Audiovisual was	Audiovisual was Excellent	Audiovisual was Good	Audiovisual was Satisfactory	Audiovisual was Poor
Facilities were	Facilities were Excellent	Facilities were Good	Facilities were Satisfactory	Facilities were Poor
Overall activity rating	Overall activity rating Excellent	Overall activity rating Good	Overall activity rating Satisfactory	Overall activity rating Poor
I would recommend this activity to others	I would recommend this activity to others Excellent	I would recommend this activity to others Good	I would recommend this activity to others Satisfactory	I would recommend this activity to others Poor

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* 4. A1 - SIBLING RELATIONSHIPS: PERSPECTIVES OF CHILDREN WITH CEREBRAL PALSY AND THEIR SIBLINGS
Leanne M. Johnston, PhD; Samantha Walter, MA; Cathryne Lang, PhD

	Agree Strongly	Agree	Neutral / No Opinion	Disagree	Disagree Strongly
Content valuable to me professionally	Content valuable to me professionally Agree Strongly	Content valuable to me professionally Agree	Content valuable to me professionally Neutral / No Opinion	Content valuable to me professionally Disagree	Content valuable to me professionally Disagree Strongly
Presentation well organized	Presentation well organized Agree Strongly	Presentation well organized Agree	Presentation well organized Neutral / No Opinion	Presentation well organized Disagree	Presentation well organized Disagree Strongly
Speaker was effective	Speaker was effective Agree Strongly	Speaker was effective Agree	Speaker was effective Neutral / No Opinion	Speaker was effective Disagree	Speaker was effective Disagree Strongly

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* 5. A2 - PSYCHOLOGICAL WELLBEING OF CAREGIVERS OF ADOLESCENTS WITH CP: IMPACT OF ADOLESCENT CHARACTERISTICS AND FAMILY SUPPORT SERVICES
Leanne M. Johnston, PhD; Breanna Holden, MA; Cathryne Lang, PhD

	Agree Strongly	Agree	Neutral /No Opinion	Disagree	Disagree Strongly
Content valuable to me professionally	Content valuable to me professionally Agree Strongly	Content valuable to me professionally Agree	Content valuable to me professionally Neutral /No Opinion	Content valuable to me professionally Disagree	Content valuable to me professionally Disagree Strongly
Presentation well organized	Presentation well organized Agree Strongly	Presentation well organized Agree	Presentation well organized Neutral /No Opinion	Presentation well organized Disagree	Presentation well organized Disagree Strongly
Speaker was effective	Speaker was effective Agree Strongly	Speaker was effective Agree	Speaker was effective Neutral /No Opinion	Speaker was effective Disagree	Speaker was effective Disagree Strongly

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* 6. A3 - COPING WITH CHILDHOOD ONSET DISABILITY AND PSYCHOSOCIAL OUTCOMES: A COMPARISON OF COPING PATTERNS ACROSS THE LIFESPAN
Alicia M. January, PhD; Erin H. Kelly, PhD; Kathy Zebracki, PhD; Heather F. Russell, PhD; Lawrence C. Vogel, MD

	Agree Strongly	Agree	Neutral /No Opinion	Disagree	Disagree Strongly
Content valuable to me professionally	Content valuable to me professionally Agree Strongly	Content valuable to me professionally Agree	Content valuable to me professionally Neutral /No Opinion	Content valuable to me professionally Disagree	Content valuable to me professionally Disagree Strongly
Presentation well organized	Presentation well organized Agree Strongly	Presentation well organized Agree	Presentation well organized Neutral /No Opinion	Presentation well organized Disagree	Presentation well organized Disagree Strongly
Speaker was effective	Speaker was effective Agree Strongly	Speaker was effective Agree	Speaker was effective Neutral /No Opinion	Speaker was effective Disagree	Speaker was effective Disagree Strongly

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* 7. A4 - LOOK AROUND ME: ENVIRONMENTAL CONTEXT FOR ADOLESCENTS WITH CEREBRAL PALSY (CP)
Keiko Shikako-Thomas, PhD; Norbert Schmitz, PhD; Allan Colver, MD; Lucy Lach, PhD; Michael Shevell, MD CM; Mary Law, PhD; Chantal Poulin, MD CM; Annette Majnemer, PhD

	Agree Strongly	Agree	Neutral /No Opinion	Disagree	Disagree Strongly
Content valuable to me professionally	Content valuable to me professionally Agree Strongly	Content valuable to me professionally Agree	Content valuable to me professionally Neutral /No Opinion	Content valuable to me professionally Disagree	Content valuable to me professionally Disagree Strongly
Presentation well organized	Presentation well organized Agree Strongly	Presentation well organized Agree	Presentation well organized Neutral /No Opinion	Presentation well organized Disagree	Presentation well organized Disagree Strongly
Speaker was effective	Speaker was effective Agree Strongly	Speaker was effective Agree	Speaker was effective Neutral /No Opinion	Speaker was effective Disagree	Speaker was effective Disagree Strongly

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* 8. A5 - AN EXPLORATORY ANALYSIS OF FACTORS THAT IMPACT SELF CONCEPT (SC) IN CHILDREN WITH CEREBRAL PALSY (CP)
Greta von der Luft, PT PhD MEd; Betty DeBoer, PhD; Sara Martino, PhD

	Agree Strongly	Agree	Neutral /No Opinion	Disagree	Disagree Strongly
Content valuable to me professionally	Content valuable to me professionally Agree Strongly	Content valuable to me professionally Agree	Content valuable to me professionally Neutral /No Opinion	Content valuable to me professionally Disagree	Content valuable to me professionally Disagree Strongly
Presentation well organized	Presentation well organized Agree Strongly	Presentation well organized Agree	Presentation well organized Neutral /No Opinion	Presentation well organized Disagree	Presentation well organized Disagree Strongly
Speaker was effective	Speaker was effective Agree Strongly	Speaker was effective Agree	Speaker was effective Neutral /No Opinion	Speaker was effective Disagree	Speaker was effective Disagree Strongly

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* 9. A6 - STABILITY OF LEISURE PARTICIPATION FROM SCHOOL-AGE TO ADOLESCENCE IN CHILDREN WITH CEREBRAL PALSY
Annette Majnemer, PhD; Keiko Shikako-Thomas, PhD; Mary Law, PhD; Norbert Schmitz, PhD; Michael Shevell, MD CM; Lucy Lach, PhD; Chantal Poulin, MD

	Agree Strongly	Agree	Neutral /No Opinion	Disagree	Disagree Strongly
Content valuable to me professionally	Content valuable to me professionally Agree Strongly	Content valuable to me professionally Agree	Content valuable to me professionally Neutral /No Opinion	Content valuable to me professionally Disagree	Content valuable to me professionally Disagree Strongly
Presentation well organized	Presentation well organized Agree Strongly	Presentation well organized Agree	Presentation well organized Neutral /No Opinion	Presentation well organized Disagree	Presentation well organized Disagree Strongly
Speaker was effective	Speaker was effective Agree Strongly	Speaker was effective Agree	Speaker was effective Neutral /No Opinion	Speaker was effective Disagree	Speaker was effective Disagree Strongly

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* 10. A7 - PREDICTORS OF PARTICIPATION OF ADOLESCENTS WITH CEREBRAL PALSY: A EUROPEAN LONGITUDINAL STUDY
Van M. Dang, MD; Heather O. Dickinson, BSc PhD; Allan Colver, MD FRCPCH; Jérôme Fauconnier, MD

	Agree Strongly	Agree	Neutral /No Opinion	Disagree	Disagree Strongly
Content valuable to me professionally	Content valuable to me professionally Agree Strongly	Content valuable to me professionally Agree	Content valuable to me professionally Neutral /No Opinion	Content valuable to me professionally Disagree	Content valuable to me professionally Disagree Strongly
Presentation well organized	Presentation well organized Agree Strongly	Presentation well organized Agree	Presentation well organized Neutral /No Opinion	Presentation well organized Disagree	Presentation well organized Disagree Strongly
Speaker was effective	Speaker was effective Agree Strongly	Speaker was effective Agree	Speaker was effective Neutral /No Opinion	Speaker was effective Disagree	Speaker was effective Disagree Strongly

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* 11. A8 - RELATIONSHIP BETWEEN DAILY PHYSICAL ACTIVITY PERFORMANCE AND FUNCTIONAL MOBILITY CAPACITY AND PERFORMANCE IN TODDLERS WITH CEREBRAL PALSY
Kristie L. Bell, PhD; Stina Oftedal, RD; Peter S. Davies, PhD; Robert Ware, PhD; Roslyn N. Boyd, PhD PT

	Agree Strongly	Agree	Neutral /No Opinion	Disagree	Disagree Strongly
Content valuable to me professionally	Content valuable to me professionally Agree Strongly	Content valuable to me professionally Agree	Content valuable to me professionally Neutral /No Opinion	Content valuable to me professionally Disagree	Content valuable to me professionally Disagree Strongly
Presentation well organized	Presentation well organized Agree Strongly	Presentation well organized Agree	Presentation well organized Neutral /No Opinion	Presentation well organized Disagree	Presentation well organized Disagree Strongly
Speaker was effective	Speaker was effective Agree Strongly	Speaker was effective Agree	Speaker was effective Neutral /No Opinion	Speaker was effective Disagree	Speaker was effective Disagree Strongly

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* 12. A9 - DOUBLE JEOPARDY: MULTIPLE VICTIMIZATIONS AMONG YOUTH WITH DISABILITY IN THE US CHILD WELFARE SYSTEM AMONG YOUTH WITH DISABILITY IN THE US CHILD WELFARE SYSTEM
Kristin L. Berg, MSW; Cheng-Shi Shiu, MSW; Michael Msall, MD

	Agree Strongly	Agree	Neutral /No Opinion	Disagree	Disagree Strongly
Content valuable to me professionally	Content valuable to me professionally Agree Strongly	Content valuable to me professionally Agree	Content valuable to me professionally Neutral /No Opinion	Content valuable to me professionally Disagree	Content valuable to me professionally Disagree Strongly
Presentation well organized	Presentation well organized Agree Strongly	Presentation well organized Agree	Presentation well organized Neutral /No Opinion	Presentation well organized Disagree	Presentation well organized Disagree Strongly
Speaker was effective	Speaker was effective Agree Strongly	Speaker was effective Agree	Speaker was effective Neutral /No Opinion	Speaker was effective Disagree	Speaker was effective Disagree Strongly

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* 13. A10 - RELATIONSHIP BETWEEN HEALTH RESOURCE COST AND PERFORMANCE OUTCOMES IN PRESCHOOL AGE CHILDREN WITH CEREBRAL PALSY; ECONOMIC ANALYSIS
Rachel Jordan, BA Physiotherapy; Michael David, PhD; Laura Pareezer, BA; Megan Kentish, MS; Lynne McKinlay, MD; Robert Ware, PhD; Roslyn N. Boyd, PhD PT

	Agree Strongly	Agree	Neutral /No Opinion	Disagree	Disagree Strongly
Content valuable to me professionally	Content valuable to me professionally Agree Strongly	Content valuable to me professionally Agree	Content valuable to me professionally Neutral /No Opinion	Content valuable to me professionally Disagree	Content valuable to me professionally Disagree Strongly
Presentation well organized	Presentation well organized Agree Strongly	Presentation well organized Agree	Presentation well organized Neutral /No Opinion	Presentation well organized Disagree	Presentation well organized Disagree Strongly
Speaker was effective	Speaker was effective Agree Strongly	Speaker was effective Agree	Speaker was effective Neutral /No Opinion	Speaker was effective Disagree	Speaker was effective Disagree Strongly

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* 14. What are the three most important things you learned from these sessions?

1)

2)

3)

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* 15. How will these sessions enhance your professional effectiveness?

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* 16. How could this CME activity be improved?

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* 17. What topics would you suggest be presented in future CME activities?

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* 18. Were the sessions presented objectively and fairly?

Yes

No (please explain)

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* 19. Was disclosure of faculty and commercial support relationships made known to you?

Yes

No (please explain)

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* 20. Was disclosure of unapproved/investigative use(s) of commercial product(s), device(s) made?

Yes

No (please explain)

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* 21. Additional Comments or Suggestions:

Thank you for your feedback