Please share your feedback regarding our recent meeting. We appreciate your candid responses.

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* 1. Your Name

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* 2. Email Address

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* 3. Cell Phone Number

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* 4. Please provide the name of your organization

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* 5. Which sector(s) do you represent?

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* 6. Before the workshop, how familiar were you with the Georgia Council on Lupus Education and Awareness?

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* 7. What questions do you have about GCLEA that were not addressed during the Workshop?

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* 8. After attending this workshop, my knowledge of the state of Lupus in Georgia has.

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* 9. Overall, how satisfied were you with this Workshop?

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* 10. How satisfied were you with the location and facilities of the Workshop?

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* 11. How satisfied were you with the food and beverages?

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* 12. How satisfied were you with the date and time of the Workshop

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* 13. Any suggestions on how we can make the next Workshop better?

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* 14. Please rate your interest in future collaboration in the following GCLEA Workgroups:

  Extremely likely Very likely Somewhat likely Not at all likely
Public Outreach & Education
Research
Provider Outreach, Education & Support
Patient Services & Resources
Workforce Development

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* 15. Please provide any additional comments/feedback to advance the work of the Georgia Council on Lupus Education and Awareness. Include your name and contact information if you would like us to respond to you directly.

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* 16. Would you be willing to provide contact information for additional stakeholders who may be interested in receiving information about the GCLEA and our meetings in the future?

If so, please enter their names and emails below:

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