Thank you for taking the time to provide feedback for our "Re-start" program at the Brain Injury Association of Waterloo Wellington. Your feedback is important to us!

* 1. What relationship do you have with brain injuries? (Select all that apply)

* 2. How many years have you been active in the ABI field (since your Acquired Brain Injury or starting your profession)?

* 3. What area do you live or work in?

* 4. What services or programs do you want to see (re)established for the Waterloo –Wellington areas? (select up to five)

* 5. As we “restart” our organization, what do you think is the most pressing need for our communities?

* 6. What roles would you be interested in participating in?  (select all that apply)

* 7. Have you been involved in the BIAWW in the past? If so, please indicate in what capacity. Why are you no longer involved in BIAWW?

* 8. Are you a current member of the BIAWW? (Through BIAWW or through dual memberships at OBIA)

* 9. Contact Information (Optional – but necessary for us to contact you for membership and participation roles)