Tell Us About Your Activities
Response Card
Please take a few minutes to tell us about your program. Print out this page and fill in the information below. Return the form to:
National Eye Institute
Building 31, Room 6A32
31 Center Dr. MSC 2510
Bethesda, MD 20892-2510
Fax: (301) 402-1065
Name of Organization: _____________________________________________
Contact Person: __________________________________________________
Address: _______________________________________________________
_______________________________________________________________
_______________________________________________________________
Telephone: ______________________________________________________
Fax/E-mail: ______________________________________________________
1. In what type of event or promotional activity did your organization participate?
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2. What other organizations did you work with to promote Healthy Vision Month?
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3. What type of Healthy Vision Month materials did you use for your event? (Please include the number you ordered and where you distributed them.)
________________________________________________________________
4. Were the materials effective in their use? Which ones were not useful?
________________________________________________________________
5. What type of media coverage or response did you get from your activities?
________________________________________________________________
6. How many people participated in your event?
________________________________________________________________
7. What other resources or new ideas did you find that helped promote Healthy Vision Month in your community?
________________________________________________________________
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