Delegate Experience Report

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* 1. What are you experiencing?

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* 2. Describe specific examples or incidents.

Delegate names help us follow-up. Anonymous reports are also helpful.

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* 3. What help do you need?

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* 4. May we contact you to discuss?

If so, please enter your name below.

Yes

No

Yes

No

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* 5. Enter your name. OPTIONAL: Leave blank if you prefer to be anonymous.