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* 1. Which events would you be interested in attending? (choose as many as you like)

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* 2. What do you think is the most meaningful way we could have an impact on our community? (choose one)

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* 3. Guest Speaker topics: Choose topics in which you would be interested.

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* 4. If you are interested in having a more active role in the PaACC WIC Section, provide your contact information and we will reach out to you.

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* 5. In what type of practice are you?

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* 6. How many years have you been in practice?

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* 7. What is your primary subspecialty or interest?

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* 8. With which platform or modality would you be mostly likely to engage?

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* 9. How often do you want to engage with PaACC WIC?

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* 10. What is your biggest barrier to participation in PaACC WIC events?

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* 11. Do you know anyone we should reach out to who would like to be part of the Pennsylvania ACC state chapter?

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