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Thank you for completing this important information about the |
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way you are conducting outreach for the National ALS Registry. |
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Please submit a form monthly for your chapter or district. |
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Org Code |
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District or Chapter Name |
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Clinic, Support Group, Seminar, Other group activities |
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Kaye, Wendy (ATSDR/DTHHS/EHSB) (CTR):
Indicate if a clinic, support group, seminar, or other group activities
Activity |
Date |
# Registry information kits distributed |
# people talked to about the Registry |
# people helped sign-up for the Registry |
City and State |
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| Total |
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Social Media and local mailings (e.g., tweet, email blast, newsletter) |
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Activity |
Date |
# |
City and State |
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| Total |
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Fundraising event (e.g., walk, golf tournament) |
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Type of event |
Date |
# attendees |
Materials distributed or displayed |
City and State |
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| Total |
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Outreach calls made where the Registry was discussed |
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# calls |
City and State |
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| Total |
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