Name___________________________________________

Address_________________________________________

City_______________________State_____Zip_________

Was this your first CSA conference? □ Yes □ No

If “No,” how many have you attended previously? ________

Are you a: (check all that apply)
□ Local CSA Chapter Member # of Yrs _____
□ CSA National Member # of Yrs _____
□ Conference Volunteer
□ Conference Exhibitor
□ CSA Governing Board Member
□ Healthcare Professional

How did you learn about the conference?
□ CSA Website
□ Conference Registration Mailing
□ Lifeline Newsletter
□ Chapter meeting or newsletter
□ Other____________________________________

For a October conference, when do you need to receive
registration materials?
□ May □ June
□ July □ August

How were your hotel contacts and accommodation?
□ Excellent □ Good □ Fair □ Poor □ N/A

1. The range of topics for your needs was:
□ Excellent □ Good □ Fair □ Poor
Comments:

2. The methods used for presentation at the
conference were:
□ Excellent □ Good □ Fair □ Poor
Comments:

3. The information presented relating to CD was:
□ Excellent □ Good □ Fair □ Poor
Comments: