1. Default Section

* 1. Name:

* 2. Date of event:

* 3. Source of event:

* 4. How well did the presentation meet your educational/informational needs?

* 5. Would you consider purchasing a plug-in hybrid electric vehicle (PHEV)?

* 6. If you answered no to question 5, please explain why.

* 7. If you currently own a hybrid vehicle, would you consider converting it to a PHEV?

* 8. If you answered no to question 7, please explain why.

* 9. If you answered yes to question 7, what would be likely source of electricity to charge the PHEV?

* 10. If you would like to be contacted for more information or updates on events, please indicate here how you would like to be contacted (phone, email, etc).

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