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)