Chapter Questionnaire

In order to plan better and more efficient campaigns, we need to know which issues are most important to you.  Please pick up to 3 issues from the list below and number the from 1 to 3 with 1 being most important.

Please Let us know where you like to help:

Tell us how to get in touch with you for any questions or follow-up:

Are you currently a member? Yes    No

Name
E-mail
Tel
Address
City, Zip

Best way to reach you? Phone    Postal Mail    E-Mail