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* 1. Name

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* 2. Contact Information

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* 3. Age

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* 4. Gender

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* 5. Race/Ethnicity

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* 6. If you are a medical provider, please specify the field:

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* 7. What is your speacialty?

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* 8. How did you hear about this program?

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* 9. Have you been to a CLA program before?

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* 10. Rate the following:

  Excellent Good Fair Poor
Materials and handouts
Audio/visual aids
Location
Overall program information
Overall program organization
Speaker(s)

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* 11. What else would you like to learn? Any suggested topics for future trainings?

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* 12. Other Comments:

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* 13. Would you like to receive more information about liver wellness and liver disease?

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* 14. Would you like to volunteer for your local CLA?

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* 15. Will you be an advocate for the CLA?

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