Survey - 2007 Long Branch Walk Feedback Form - The ALS Association Greater New York Chapter

Thank you for taking the time to fill out this post-walk questionnaire. Your responses will allow us to evaluate how we execute our walks and continue to make improvements to the process. If you have any questions, please contact Jenn Lowy.

1.

*=Required


	Title:
*	First Name: Required
*	Last Name: Required
*	Email: Required
	If you respond and have not already registered, you will receive periodic updates and communications from The ALS Association.

*2.

Question - Required - Team Name:

(Maximum response 255 chars, approx. 5 rows of text)

*3.

Question - Required - How many years have your participated in the Walk to D'Feet ALS?

*4.

Question - Required - How many years have you served as a Team Captain?

*5.

Question - Required - Would you be interested in being a Team Captain next year?

*6.

Question - Required - How did you hear about the Walk to D'Feet ALS?
Please make at least 1 selection from the choices below.

	Family/Friends
	PALS
	Past Participant
	TV
	Radio
	Newspaper
	Workplace
	ALS Staff
	ALS Website
	Doctor/Nurse/Hospital
	NorthFork Bank
	Duane Reade
	Community Calendar
	Other (Specify Below)

7.

Question - Not Required - If Other, please specify:

*8.

Question - Required - Which of the following describes you?
Please make at least 1 selection from the choices below.

	I am an ALS Patient
	I have family/friend/co-worker with ALS
	I am walking in memory of family/friend/coworker with ALS
	I participated to support the fight ALS
	I am involved through my company
	Other (specify below)

9.

Question - Not Required - If Other, please specify:

Please rate the following:

*10.

Question - Required - Event Organization: 1-Poor
2
3-Average
4
5-Execellent
N/A

*11.

Question - Required - Check-in Process: 1-Poor
2
3-Average
4
5-Execellent
N/A

*12.

Question - Required - Accessibility of Staff: 1-Poor
2
3-Average
4
5-Execellent
N/A

*13.

Question - Required - Driving Directions: 1-Poor
2
3-Average
4
5-Execellent
N/A

*14.

Question - Required - Location of Event: 1-Poor
2
3-Average
4
5-Execellent
N/A

*15.

Question - Required - On Site Facility: 1-Poor
2
3-Average
4
5-Execellent
N/A

*16.

Question - Required - Entertainment: 1-Poor
2
3-Average
4
5-Execellent
N/A

*17.

Question - Required - T-Shirts: 1-Poor
2
3-Average
4
5-Execellent
N/A

*18.

Question - Required - Community Involvement: 1-Poor
2
3-Average
4
5-Execellent
N/A

As a Team Captain, please answer the following:

19.

Question - Not Required - Did you attend the New Jersey Kick-Off Party?

20.

Question - Not Required - If No, why not?

(Maximum response 255 chars, approx. 5 rows of text)

21.

Question - Not Required - If Yes, did you receive the following at the event:

	Fundraising Ideas
	Brochures
	Walk Materials
	ALS Education
	Donation Envelopes
	Other (specify below)

22.

Question - Not Required - If Other, please specify:

23.

Question - Not Required - Did you receive any mailings or email communications regarding the Walk?

24.

Question - Not Required - If Yes, how many and what?

(Maximum response 255 chars, approx. 5 rows of text)

25.

Question - Not Required - Comments: