Dying With Dignity Survey: How Ready Are You?

1. Personal Information

Thank you for participating in this survey. We're delighted that you are going to help shape the future of Dying With Dignity Canada!

This survey is open to the public. The purpose of the survey is to provide us with information about how
many of our members, supporters and the general public have completed an Advance Care Plan.

Question Title

* 1. Are you a member of DWD?

Yes. I'm a life member.

Yes. I'm a current member.

No. I have been a member in the past, but I'm not now.

No. I've never been a member.

Not sure.

Other (please specify)

Question Title

* 2. Are you a financial supporter of DWD?

Yes. I have donated since January 1, 2013.

Yes. I have donated in the past.

No.

Not sure.

Other (please specify)