* 1. What PVAC programs have you participated in?

* 2. What issues would you be interested in working on?

* 3. What is the best time for the Coalition to meet?

* 4. What do you want to get out of the Coalition meetings?

* 5. What group do you represent?

* 6. What other ideas or suggestions do you have for the Coalition?

* 7. Please help us update our list by providing your contact information. Your information is confidential.
(If you would like to participate in a committee, we will need your contact information below.)

Thank you for participating in this survey. Your input will help us plan future activities for the Coalition.
We will report on the results to the next Coalition meeting.

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