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Activity Information

Please complete the survey below to help track local efforts and identify areas for future activities.

1. Your Name

2. Name of organization facilitating the activity

3. Which sector best describes your organization?

4. Contact Information (phone and/or email)

5. Date of activity (MM/DD/YY)

6. Type of activity

7. "Rethink Your Drink" information presented by (select all that apply)

8. Number of individuals reached by this "Rethink Your Drink" activity

9. Target audience reached (select all that apply)

10. Income level of target audience

12. Which sector best describes the audience reached by this "Rethink Your Drink" activity? (select one)

13. "Rethink Your Drink" materials used (select all that apply)