Last Name:                         

First Name:                         

Email Address (preferred)                 

Telephone Number:            

Fax Number  (optional)                               

Company Name: (optional)       

What course subjects would you take if offered ?

What courses would you instruct ?                      

What program subjects do you want to see presented at monthly meeting?

Would you give a presentation at an ASQ monthly meeting ? If so, what subject ?

What does the Cleveland Section do best ?          

What does the Cleveland Section do worst at ?    

Are you interested in participating in any of the following focus groups ?

                                             Nursing ?                       

                                             Healthcare ?                     

                                             Regulatory Compliance ?

                                             Banking/Finance ?          

Your Comments: