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Local Chapter-Groups Member Survey

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Hadassah Member Survey

[name of your chapter/group]

Chapter Website or email address

                           This is your Hadassah. Help us get to know you better!


Please complete and return this survey to            [email]___________________. If you have any questions or suggestions, please contact ____[name]___________                   at _____[email/phone]______________. Thank you in advance for your participation.


Name                                                          Phone (day)                                   (eve)


Email Address                                        Cell Number                                          Birthday


What is your current membership status?  

º Annual Member          º Life Member              q Associate Member      q Not yet a member


What made you decide to become a member of Hadassah? (Can revise to match your community)

q Support the mission                 q Friend asked                          q Gifted by______________   

q Connection to Israel               q Transfer from another community


q Support research for:             q Breast Cancer           q Stem Cell                   q Diabetes

                                                 q Ovarian Cancer         q Multiple Sclerosis        q Parkinson’s Disease

q Advocate for health issues at the national and local level           q Support Hadassah College Jerusalem q Support Children at Risk - Youth Aliyah         q Support education on health & related issues 

q Participate in Al Galgalim        q Other____________________________________________


What age category applies?

q Under 21       q 21-30           q 31-45            q 46-55            q 56-64            q 65+ 


What is your profession and background:



What is/are your area(s) of expertise?

q Computer                  q Financial        q Medical         q Graphics        q Web/Blogs

q Public Speaking          q Marketing      q Leadership Development        q Jewish Education

q Fundraising                q Writing          q Other                                                                                   


How often would you be interested in participating in a Hadassah event?

q Several times a month            q Once a month            q Special events only        q Not at all


In which activities or programs would you most likely participate? (Check one or more)

q Book Reviews                   q Career Issues                 q Environmental programs        

q Issue Advocacy                 q Finance                          q Family Events            q Couples Events

q Daytrips/Travel                 q Social Events                  q Health/Women’s Issues         

q Community Volunteering    q Other                                                                             _____


What time of day are you most often available for Hadassah activities? (Check one or more)

q Weekday Mornings                 q Weekday Afternoons              q Weekday Evenings    

q Sunday Mornings                    q Sunday Afternoons                 q Sunday Evenings                   


Would you like to volunteer with Hadassah?           q Yes               q No

If yes, would you:          q Assist with phone calls            q Provide home for meeting/event           

q Help with short-term project   q Help with long-term project     q Other                                               


Have you ever held a chapter or group board position?

q Yes q No   q If yes, which position(s)? ___________________________________________________   



We care about the environment. Would you be willing to receive communications via email?

q Yes               q No


Please check off any social networking site you use.

q Facebook                  q Twitter                      q LinkedIn                    q Other___________________


Please share some of your family demographics with us:

q Single                        q Married (Husband’s name_____________________________________)

Children: q Ages 0-5     q Ages 6-12      q Ages 13-18    q Adult Children


How long have you lived in this area? ___________________________________________


Do you belong to a synagogue?___________Which one?__________________________


Are you active with other organizations in town? q Yes - Which ones?________________     q No 


             Please share any of your special talents or areas of expertise you’d be willing to share:   


             Please tell us if you have any thoughts or ideas for an interesting program or event:



Please share the name(s) and contact information of prospective members:




Thank you for participating in this survey. 


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