Personal Information

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* 1. Name

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* 2. Email Address

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* 3. Home Address

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* 4. Work Address

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* 5. What is your primary practice environment?

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* 6. Type of Practice/Specialty

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* 7. What best describes your role?

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* 8. How many years have you been in neurology practice?

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* 9. What is the most important factor in your decision to attend the ACNN Annual Conference?

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* 10. What specific topics are of interest to you?

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* 11. How often have you attended the ACNN Annual Meeting in the last 5 years?

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* 12. In the past, ACNN education content has been:

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* 13. On a scale of 1-5, please rate your overall 2016 ACNN Annual Meeting experience

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* 14. What challenges/issues confront you in your practice that you would like ACNN to address in the educational activities?

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* 15. Please respond to each comment.

  N/A Strongly Disagree Disagree Agree Strongly Agree
The overall program content was valuable.
The structure of the program was conducive to learning.
The program was well organized.
There were opportunities to network.
The program was free of commercial bias toward any product or service.
I would recommend this program to a colleague.
The program met my education needs/expectations.
The time allotted for each topic area was adequate.
The environment was conducive to learning.
The program provided evidence-based information that will be useful to me in my job or practice.

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* 16. Do you plan to attend the 2017 meeting in Kansas City, MO?

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* 17. How could this program be improved?

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* 18. Additional comments or ideas for future education events. (Example: Topics/Speakers you would like to hear from next year's meeting, things you would like the ACNN to be sure to continue)

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* 19. Will you change the way you practice based on this educational activity? 

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