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Activity Information

Please complete the survey below to help track local efforts and identify areas for future activities.

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* 1. Your Name

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* 2. Name of organization facilitating the activity

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* 3. Which sector best describes your organization?

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* 4. Contact Information (phone and/or email)

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* 5. Date of activity (MM/DD/YY)

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* 6. Type of activity

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* 7. "Rethink Your Drink" information presented by (select all that apply)

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* 8. Number of individuals reached by this "Rethink Your Drink" activity

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* 9. Target audience reached (select all that apply)

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* 10. Income level of target audience

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* 11. City where activity was completed

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* 12. Which sector best describes the audience reached by this "Rethink Your Drink" activity? (select one)

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* 13. "Rethink Your Drink" materials used (select all that apply)

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