Exit this survey Question Title 1. How did you receive the Conference Brochure for Women’s Health 2014: The 22nd Annual Congress? Check all that apply. If you did not receive the brochure and wish to access it, please visit www.congress.academyofwomenshealth.org. Mail Email The brochure was given to me by a colleague The email was forwarded to me by a colleague Don’t recall No, I did not receive the brochure Question Title 2. Do you prefer receiving the Congress brochure via: Mail Email Question Title 3. How far in advance do you wish to receive information about the Congress in order to plan to attend? 6 months 3-6 months less than 3 months Other (please specify) Question Title 4. How often would you like email updates? Weekly Twice a Month Monthly Question Title 5. What conferences do you plan to attend in 2014? Please select all that apply. n/a - I am not planning on attending any conferences in 2014 Women's Health 2014: The 22nd Annual Congress other conferences (please specify) Question Title 6. Which are the top factors that influence your decision to attend a conference? Please check the top three that apply. Conference dates Length of conference (Number of days) Registration rates Travel & lodging costs Number of CME/CNE credits available Type of CME/CNE credits available (e.g. AMA, AANP, AAFP, etc.) Conference learning objectives Program content (topics/therapeutic areas) Faculty Program format Networking opportunities Other (please Please list any other factors that are important) Question Title 7. Have you previously attended the Women's Health Congress? Check all years that apply. I never have but I will in 2014 2013 2012 2011 2010 2009 Prior to 2009 Don't recall I never have and I'm not interested in attending Question Title 8. I am a member of the following professional organizations related to women’s health: Academy of Women's Health Other (please specify) Question Title 9. Which membership benefits are most important to you? (Please check the top three that apply.) Congress Discount Abstract Presentation Opportunities Prestige Networking Opportunities Free online subscription to peer-reviewed Journal of Women’s Health International Travel Programs Other (please specify) Question Title 10. Please email me information about: (select all that apply) Program and registration for Women’s Health 2014: The 22nd Annual Congress Academy of Women’s Health Membership for 2014 Question Title 11. Please choose your suffix/degree. MD PhD NP RN MPH Resident/Intern Other (please specify) Question Title 12. What is your specialty? Internal Medicine OB/GYN Other (please specify) Question Title 13. Thank you for completing the survey. Please enter your contact information. Once you submit your survey you will be entered to win a free online subscription to the Journal of Women's Health (over a $450 value). Name: * Company: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Country: * Email Address: * Phone Number: Done
