Penn-York ACS Survey

Please provide the following contact information:

First name
Last name
Title
Organization
Street address	*
Address (cont.)	*
City	*
State/Province
Zip/Postal code
Country	*
Work Phone	*
E-mail	*
URL	*

Fields marked * are optional.....however they are appreciated....

Please select your membership status...

ACS Member
Non-ACS Member
Student affiliate

How many meetings have you attended in the last three years?

0
1-3
3-5
5-7
7-10
10+

How would you rate your opinion of meeting locations?

bad poor average fair good

Where would you like the next meeting to be held? Please keep in mind that the Penn-York Section is very large geographically... a centralized location is best for most members.

How would you rate your opinion of topics...?

bad poor average fair good

What topics/subjects would you like to see addressed?

Please note... a wide range of speakers from various industries and academic specialties are available! Your input is IMPORTANT here!

Have you used the Penn-York webpage before now?

Yes
No

Would you like to be notified via e-mail of upcoming meetings/announcements? If so, please submit your e-mail address in this form.

Would you like to submit the URL of this site to a friend or fellow member? If so, please submit their e-mail address in the space provided:

How would you rate your opinion of the Penn-York webpage ... ?

bad poor average fair good

Any suggestions as to what you'd like to see on the Penn-York website?

Please provide additonal comments or suggestions.

Please send any comments/difficulties/suggestions to Penn-York webmaster
Last revised: October 02, 1999

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