2017 NIAW Event Survey
| Thank you for planning an event during National Infertility Awareness Week® (NIAW) Please remember to submit information for each event separately. All events will be posted within 3 business days. Postings received without sufficient information or that are not related to NIAW will be returned to the individual submitting the event. | ||||||||||||||||||||||||||||||||||||||
| *1. |
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| *2. | Question – Required – Time event takes place, including US Time Zone (example: 9:00PM – 10:00PM)
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| *3. | Question – Required – Location of the event: (Maximum response 255 chars, approx. 5 rows of text) |
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| *4. | Question – Required – Title of Event (40 character limit)
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| *5. | Question – Required – 50 word description of event, including the name of the business hosting the event, the cost to attend and a contact name, phone number and URL link for consumers to register for the event or ask questions.
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| 6. | Please fill out the following information:
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| *7. | Question – Required – Event Contact First Name:
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| *8. | Question – Required – Event Contact Last Name:
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| *9. | Question – Required – Event Contact Email: (Maximum response 255 chars, approx. 5 rows of text) |
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| *10. | Question – Required – Company/Organization Name (hosting the event): (Maximum response 255 chars, approx. 5 rows of text) |
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| *11. | Question – Required – Company/Organization Address:
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| *12. | Question – Required – Contact Phone Number:
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| *13. | Question – Required – Specialty:
Please select response
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| 14. | Question – Not Required – Company Street Address (if different than the location address):
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| 15. | Question – Not Required – Company Street Address 2: (if different than the location address):
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| 16. | Question – Not Required – Company City (if different than the location address):
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| 17. | Question – Not Required – Company State (if different than the location address):
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| 18. | Question – Not Required – Company zip code (if different than the location address):
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