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The Hemophilia Association of the Capital Area, Hemophilia of NC, Hemophilia of SC, and the Virginia Hemophilia Foundation have been discussing the idea of collaborating on a two-day/two night regional men's retreat. We are reaching out to our collective communities to see if there is enough interest to move forward.

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* 1. Would you be interested in attending a regional men's retreat with Hemophilia Association of the Capital Area, Hemophilia of NC, Hemophilia of SC, and the Virginia Hemophilia Foundation?

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* 2. Please explain why you would or would not be interested in participating:

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* 3. Are there obstacles that would prevent you from attending?

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* 4. If you are interested in attending, how far are you able to travel?

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* 5. Are there any special considerations we should be aware of (i.e. difficulty walking, need wheelchair accessibility, etc.)?

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* 6. Please rank your interest in the following modes of travel:

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* 7. What time of year would work best for your schedule?

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* 8. What educational topics would be of interest to you?

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* 9. What physical/social activities would be of interest to you?

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* 10. What locations would be of interest to you?

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* 11. Anything to add?

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* 12. What is your role in the community? (please check all that apply)

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* 13. What is your age?

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* 14. What is your gender?

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* 15. Where do you live?

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