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* 1. Would you be willing to have your basic information (contact information, research interests, publication history) in a database available to (please mark all that apply):

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* 2. Which of the following RSA services would you list yourself as willing to provide? (please mark all that apply)

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* 3. Which of the following RSA services would you be likely to use? (please mark all that apply)

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* 4. Regardless of whether you participate now, would you be interested in participating in a Pelvic Floor Disorders research registry in the future (including surgical and non-surgical patients)?

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* 5. Which two factors would be the most likely to influence your decision to participate in a Pelvic Floor Disorders research registry? Please select two

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* 6. Please enter any additional comments below (i.e. who should have access to RSA services and for what cost; how AUGS can better facilitate research for its members; what is most important to you in a research registry, etc)

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