To download, click Survey
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.