Partner Survey Page

* First Name:

* Last Name:

* Email:

* Phone:

* Org phone number

* Org Website

* Org vision/mission statement

* Program overview and focus

* Program statistics (Please include number of programs, number of people served, and any other measures of impact.)

* Geographic area served

* Date Founded

* Security Question: 9 + 8 = ?

Submission Date:

*What ways of partnering would be most helpful to you?

Co-promotions/marketing/branding Discounts for membership, service, products, events, etc Sharing research, best practices Joint scholarship and research Advocacy Community conversations

*What publications are you interested in?

Magazines Journals Newsletters

*Organization type

Nonprofit For profit

*What ways could you provide discounts to affiliate organizations?

*Do you host conferences or regional events? If so, list them below and include event type, purpose, size, frequency, and dates.

*Are you a membership organization? If yes, how many individual members? How many organizational members?

*Product(s) Provided

*Service(s) Provided

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