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* 1. What is your name?

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* 2. What is your email address?

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* 3. What is the name of your organization, and your current role?

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* 4. How would you describe your current organization?  (public, large private, small private, non-profit, etc)

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* 5. Where are you located?

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* 6. What are you looking for from a women’s organization? (choose top 5)

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* 7. What is the best way for you to receive content?  (check all that apply)

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* 8. What other groups do you participate in? (check all that apply)

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* 9. What time of day is best for you to attend a WISR event?

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* 10. Would you be interested in forming a local/regional WISR chapter?

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* 11. Would you be interested in taking on a leadership role at a local or national level?

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* 12. I am interested in being a...  (check all that apply)

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* 13. Would your company be interested in being a founding sponsor of WISR, and if so, who would be the best contact?

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* 14. How often do you want to be updated with news from WISR?

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* 15. Who else should we be contacting? (name, email, phone, company name)

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* 16. Any other thoughts that you would like to share with us?

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