2016 ASG Census - Help us help your ASG!

Every day, UOAA receives calls from people who are seeking local resources. Please help us refer people to your group by completing the questions below.

We would like to have uniform information for every ASG, so even if you recently updated your contact information with us, please complete this survey.

You can respond online or with the form that is being mailed with ASG dues letters – you do not need to do both.

Please respond by April 30th at the latest. If we receive your survey by March 31st, we will enter your ASG into an incentive drawing to be held at 9:00 a.m. Eastern time on April 1st. Five ASG names will be drawn to receive a $50 gift card that can be used for refreshments at your upcoming group meetings.

Thank you for everything you do!

Question Title

* 1. Please enter your ASG number, name, and meeting location.

ASG Number:

ASG Name:

Meeting Location:

Question Title

* 2. Mailing Address

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

Question Title

* 3. Does your ASG have a website or Facebook page?

Yes

If yes, please list website and/or Facebook page address:

Question Title

* 4. Who should be listed in The Phoenix and on UOAA's website as the public contact for your ASG? Please list name, title, phone number, and e-mail address. If your contact does not have an e-mail account, please indicate that.

Contact Person:

Question Title

* 5. Who are your main contacts for communications with UOAA? Please include at least 2 names, listing name, title, phone number, and e-mail address for each person.

Contact 1:

Contact 2:

Question Title

* 6. Who are your additional officers/leaders? Please list the name, title, phone number, and e-mail address for each person who is not already listed under question 5 above (if any).

Question Title

* 7. Have any of your ASG Leaders attended UOAA's National Conference, or a regional conference offered by an ASG?

Yes

If YES, please specify the conferences attended:

Question Title

* 8. How many members does your ASG have? How many attend meetings? When are your meetings held?

Number of members:

Typical meeting attendance (a range is fine):

Meeting schedule (we know this can vary):

Question Title

* 9. What is the age range of your group's members?

Age range:

Question Title

* 10. Do you accept/store donated ostomy supplies to give to those in need?

Yes

Question Title

* 11. Does your ASG have a newsletter?

Yes

If yes, how is your newsletter distributed? (E-mail, US mail, or other?)

Question Title

* 12. If your ASG has a newsletter, how often is it sent?

Monthly

Quarterly

Other (please specify)

Question Title

* 13. Information regarding your ASG's Visitor Program

Number of trained visitors:

Do you have a visitor who speaks a language other than English? If yes, please list visitor's type of ostomy and language spoken:

Question Title

* 1. Please enter your ASG number, name, and meeting location.

Question Title

* 2. Mailing Address

Question Title

* 3. Does your ASG have a website or Facebook page?

Question Title

* 4. Who should be listed in The Phoenix and on UOAA's website as the public contact for your ASG? Please list name, title, phone number, and e-mail address. If your contact does not have an e-mail account, please indicate that.

Question Title

* 5. Who are your main contacts for communications with UOAA? Please include at least 2 names, listing name, title, phone number, and e-mail address for each person.

Question Title

* 6. Who are your additional officers/leaders? Please list the name, title, phone number, and e-mail address for each person who is not already listed under question 5 above (if any).

Question Title

* 7. Have any of your ASG Leaders attended UOAA's National Conference, or a regional conference offered by an ASG?

Question Title

* 8. How many members does your ASG have? How many attend meetings? When are your meetings held?

Question Title

* 9. What is the age range of your group's members?

Question Title

* 10. Do you accept/store donated ostomy supplies to give to those in need?

Question Title

* 11. Does your ASG have a newsletter?

Question Title

* 12. If your ASG has a newsletter, how often is it sent?

Question Title

* 13. Information regarding your ASG's Visitor Program

Question Title

* 14. Please add any comments or additional explanations: