National Office Outreach Reporting

[ATSDR] National Amyotrophic Lateral Sclerosis (ALS) Registry

Att6B National Office Outreach Reprt.xlsx

National Office Outreach Reporting

OMB: 0923-0041

Document [xlsx]
Download: xlsx | pdf












Thank you for completing this important information about



the way you are conducting outreach for the National ALS



Registry. Please submit a form monthly for your organization.














Org Code






















Clinic, Support Group, Seminar, Other group activities






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
































Total























Social Media and local mailings (e.g., tweet, email blast, newsletter)






Activity Date # City and State


































Total























Fundraising event (e.g., walk, golf tournament)






Type of event Date # attendees Materials distributed or displayed City and State

































Total























Outreach calls made where the Registry was discussed






# calls City and State




































Total















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