* 1.
Question - Required -
Please provide your full name:
* 2.
Question - Required -
Please provide your e-mail address:
* 3.
Question - Required -
Which Walk did you participate in?
* 4.
Question - Required -
What are the main reasons that you decided to participate in the Walk? (Check all that apply)
5.
Question - Not Required -
Have you or your family members received assistance or attended a program through your local Alzheimer's Association chapter?
Please select response
Yes
No
6.
Question - Not Required -
Would you like to receive more information about Alzheimer's disease or Dementia programs in your local area?
Please select response
Yes
No
7.
Question - Not Required -
Which best describes your role/participation in the Walk? Please select all that apply.
8.
Question - Not Required -
How did you register for the Walk?
Please select response
Online before the event
Offline (paper form) before the event
A family member or team captain registered me
Over the phone
At the walk
9.
Question - Not Required -
What is one thing we can do to improve the registration process?
(Maximum response 255 chars, approx. 5 rows of text)
* 10.
Question - Required -
Did you fundraise:
Online Offline Both I did not fundraise
11.
Question - Not Required -
If you did not fundraise, please tell us why.
(Maximum response 255 chars, approx. 5 rows of text)
* 12.
Question - Required -
How did you obtain your donations for this event? Please select all that apply.
13.
Question - Not Required -
How can we improve the fundraising aspect of the Walk? What would make fundraising easier?
(Maximum response 255 chars, approx. 5 rows of text)
14.
Question - Not Required -
What was your overall impression of the Walk day experience?
(Maximum response 255 chars, approx. 5 rows of text)
Please rate the following elements of Walk:
* 15.
Question - Required -
Communication prior to the event
Excellent Good Fair Poor N/A
* 16.
Question - Required -
Registration process (prior to Walk Day)
Excellent Good Fair Poor N/A
* 17.
Question - Required -
Registration/Check-in on event day
Excellent Good Fair Poor N/A
* 18.
Question - Required -
Opening Ceremony
Excellent Good Fair Poor N/A
* 19.
Question - Required -
Mission Message
Excellent Good Fair Poor N/A
* 20.
Question - Required -
Education about Alzheimer's disease and the Association
Excellent Good Fair Poor N/A
* 21.
Question - Required -
Staff and volunteer assistance
Excellent Good Fair Poor N/A
* 22.
Question - Required -
Fundraising recognition
Excellent Good Fair Poor N/A
* 23.
Question - Required -
Were you asked to learn more about our Advocacy or TrialMatch program on Walk Day?
Please select response
Yes
No
* 24.
Question - Required -
Were you able to attend any "Pre-Walk" events (i.e. Walk Kick Off, supply lunches, etc.)? If not, please tell us why not.
(Maximum response 255 chars, approx. 5 rows of text)
* 25.
Question - Required -
How did you initially learn of the Walk?
Friend or family member Employer or colleague Poster, brochure, or sign Media advertisement News story Other
* 26.
Question - Required -
Prior to the Walk, where did you see or hear information about the event. Please check all that apply:
* 27.
Question - Required -
Would you be willing to help us talk to your employer about becoming a Walk sponsor?
Please select response
Yes
No
* 28.
Question - Required -
What other active/charitable events do you participate in within your community?
(Maximum response 255 chars, approx. 5 rows of text)
29.
Question - Not Required -
Please provide any additional comments or suggestions you have about the Walk To End Alzheimer's.
(Maximum response 255 chars, approx. 5 rows of text)
