Member Survey

Please take a few moments to complete this membership survey. The information you provide will help us to understand what programs and services you want from your TSA Chapter.

Protecting your privacy and your information is a top priority at TSA-RMR. We take careful measures to prevent loss, misuse, and alteration of your information. TSA-RMR does not, and will not sell or share your information to third parties without your explicit permission.

First Name
Last Name
Address
City
State
Zip Code
Home Phone
Work or Cell Phone
Email Address
Employers
Describe your connection with this chapter

How long have you been a member of TSARMR?

How did you first hear about TSA Rocky Mountain Region Chapter?
How would you like to receive Chapter news?
What Chapter services do you value most? (rate from 1 to 13 with 1 being most valuable):

Web-site Information
Telephone Services
Information & Referral Services (to other service providers; physicians, facilities)
Support Groups (check interests: families__, children__, men__, women__, adults__)
Conferences & Training Events
Fund-Raising Social Events
Recreational Social Events
Individual Support (phone calls, personal consultation)
Advocacy/Presentations at Schools/Colleges
Newsletter & Informational Material
Medical Professional Awareness & Education Programs
Legislative Awareness
Other (please specify):

This Chapter is always in need of volunteers. Can you help? Please indicate below what positions are of interest to you and that you want to learn more about:

Administrative
Media Relations
Writing (Newsletter, notices, etc)
Fundraising
Event Planning/Organizing
Grant Writing
Educational Services & Advocacy
Medical Program Liaison
Legal Services
Bookkeeping
Volunteer Recruitment/Organizing
Computer Services (technology, database management, processing)
Committee or Board Member Positions
Other __________________________________________________________
My background and/or special talents are:
My time commitment is:
Other comments, thoughts, ideas you would like us to know:

Thank you for taking the time to respond to this survey. May one of our volunteers telephone you to talk about your ideas? yes no

 

 

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