Workshop organizers are soliciting community feedback so that the agenda can be tailored to best meet the needs of the participants. The goal of the workshop is to bring leaders of anti-harassment efforts together to share ideas and discuss best practice methods to reduce harassment in the workplace. The intended audience of this workshop is the science professional community, including field-work intensive sectors. This includes government and academia.

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* 1. Are you interested in attending the workshop?

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* 2. First Name

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* 3. Last Name

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* 4. Job Title/Specialty

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* 5. Affiliation

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* 6. E-mail Address

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* 7. Telephone

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* 8. Area(s) of Anti-Harassment Related Expertise

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* 9. The schedule is under development, but the planning committee is tentatively planning a two–three day workshop.  How many days would you be willing to attend the workshop?

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* 10. What topics would you like to see covered at this workshop?  (choose all that apply)

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* 11. Would you be interested in leading a breakout session (panel/discussion/talks)?

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* 12. Do you have an anti-harassment related effort that you would like to advertise or share with others at this workshop in a format such as a poster session?

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* 13. Any other comments or questions?

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