Women's Initiative Education Kit Survey

Thank you for viewing the Women's Initiative Education Kit. We hope you found the information helpful. We very much appreciate your commitment to supporting a healthy and safe community.
In order to help our mission to reduce prescription drug abuse, please answer the following questions regarding your experience with the Women's Initiative Education Kit. This short survey should take less than 10 minutes to complete.
The asterisks (*) designate questions that require answers.

* 1. Please enter your contact information.

* 2. What is your age range?

* 3. What is your gender?

* 4. What date was your Viewing Party held?

* 5. Was the Viewing Party work related or was it a social gathering?

* 6. In what zip code was the Viewing Party held?

* 7. How many people attended your Viewing Party?

* 8. How many copies of the Education Kit did you hand out?

* 9. How many Pledge Cards did you receive back?

* 10. What was the general reaction of your guests? What were the most common comments?

* 11. Do you have any suggestions for others who may be hosting a Viewing Party in the near future, or other comments?

Thank you for your continued support and committment to preventing prescription drug abuse in our community.