Community conversation facilitator preferences Question Title * 1. Please tell us about your availability. Best availability Sometimes available Not available Weekdays Weekdays Best availability Weekdays Sometimes available Weekdays Not available Evenings Evenings Best availability Evenings Sometimes available Evenings Not available Weekends Weekends Best availability Weekends Sometimes available Weekends Not available Other (please specify) Question Title * 2. Are there specific days/evenings when you are not available? If yes, please specify. Sunday Monday Tuesday Wednesday Thursday Friday Saturday Question Title * 3. How far are you willing to travel for a focus group (distance and/or time)? Question Title * 4. Please provide current contact information below. (Note: we use your address to factor in travel time to a focus group before we ask you to facilitate.) Name Company Address Address 2 City/Town State/Province -- 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 Email Address Phone Number Question Title * 5. Anything else we should know about your availability? Done