Survey - 2022 Virtual LUNG FORCE Advocacy Day

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2022 Virtual LUNG FORCE Advocacy Day

April 6, 2022

*Required fields marked with an asterisk

Contact Information:


*	First Name: Required
*	Last Name: Required
	Professional Suffix:
*	Email: Required
*	Address Line 1: Required
	Address Line 2 (Optional):
*	City: Required
*	State: Required
*	Zip Code: Required
*	Phone Number: Required
	Yes, I would like to receive e-mail from the American Lung Association
	Yes, I would like to receive postal mail from American Lung Association
	Keep me logged in. What's this? Remembers your login information for your convenience. Use only on trusted, private computers. Privacy Policy

Question - Not Required - Current Mailing Address (If different than home address above)

*

Question - Required - Cell Phone:

*

Role:

(Select one of the available choices or enter a different value.)
Question - Required -Role: Click this to indicate that you will select an existing value. Tab to next input." Role:
Role: Click this to indicate that you will enter a new value. Tab to next input." Role: Provide your answer here

If you are a LUNG FORCE Hero, please provide additional info?

(Select one of the available choices or enter a different value.)
Question - Not Required -If you are a LUNG FORCE Hero, please provide additional info? Click this to indicate that you will select an existing value. Tab to next input." If you are a LUNG FORCE Hero, please provide additional info?
If you are a LUNG FORCE Hero, please provide additional info? Click this to indicate that you will enter a new value. Tab to next input." If you are a LUNG FORCE Hero, please provide additional info? Provide your answer here

Question - Not Required - What mode of communication works best for you? (Select all that apply)

	Email
	Texting
	Phone Call

Question - Not Required - What days are generally more open for you to join training webinars/calls ? (Select all that apply)

	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday
	Sunday

Question - Not Required - What time of day is generally more open for you to join training webinars/calls? (Select all that apply)

	Mornings (8am-12pm ET)
	Afternoons (12pm-5pm ET)
	Evenings (5pm-9pm ET)

Question - Not Required - If you are a LUNG FORCE Hero, have you already submitted a photo and your personal story to LUNGFORCE.org?

Question - Not Required - If yes, would you like to update your story or photo? Please provide the link, if it is already posted on LUNGFORCE.org.

(Maximum response 255 chars, approx. 5 rows of text)

If no, please ask your local Lung Association staff contact to help submit your story.

*

Question - Required - Do you use social media?

Question - Not Required - I would be willing to share American Lung Association and LUNG FORCE-related information on:

	Facebook
	Twitter
	Instagram
	Snapchat

*

Question - Required - Have you met with members of Congress, or congressional staff before?

Question - Not Required - If yes, what year(s):

	2021
	2020
	2019
	2018
	2017
	2016
	2015
	2014
	2013

Question - Not Required - Do you have personal contacts in your members' offices?

Question - Not Required - If applicable, please provide the name of the Lung Association staff person completing this registration:

Spam Control Text: Please leave this field empty

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