Quality Workgroup Interest Survey

1.Name (First and Last):
2.Title:
3.Email:
4.Program or Site Name:
5.What days best accommodate your participation in the workgroup?
6.What time of day best accommodates your participation in the workgroup?
7.What areas/topics would you be interested in working on or hearing about during workgroup sessions? (Check all that apply)
8.Do you have any suggestions or specific ideas for activities for the workgroup?
9.Would you like to invite any other members to join the workgroup? (Add their name and email below)