1) Name:
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2) E-Mail:
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3) Telephone where you can be contacted:
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4) What is the best time of the day to contact you at this telephone number? (Check all that apply)
Morning
Afternoon
Evening
Do Not Contact Me by Telephone
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5) What is the best way to contact you?
Telephone
E-Mail
Fax (Please provide fax # below)
U.S. Mail (Please provide mailing address below)
Other:
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6) Fax Number:
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7) Mailing Address:
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8) If contacting you by telephone, do you use a telecommunications device for the deaf (TTY/TDD machine)?
Yes
No
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9) How satisfied were you with the technology and multimedia available at this workshop?
Very Dissatisfied
Dissatisfied
Satisfied
Very Satisfied
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10) The size of the room for your workshop was:
Too large
Just about right
Too small
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11) Approximately how many participants attended your workshop?
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12) The number of participants at your workshop were:
Too many
Just about right
Too few
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