1. Please indicate your level of interest in engaging around the following potential goals for this group:

2. Which one of these goals would be most useful or interesting to you?
a. To discuss health policy communications issues
b. To network
c. To learn (or improve on) effective strategies for working with journalists
d. To learn how to create (or improve on) effective health policy communications
e. To learn how to effectively translate research into newsworthy or policy worthy content

3. Please use this space to recommend other goals that this group should pursue.

4. Please recommend specific guest speakers or topics you would like for this group to showcase in the upcoming year.

5. How many times in the past five years have you attended the following:

6. How would you prefer to participate in activities or events sponsored by this interested group? (Please check all that apply.)
a. Audio conference that feature a guest speaker or panel
b. Audio conference with open discussion among participants
c. In-person meetings in conjunction with the Annual Research Meeting
d. In-person meeting in conjunction with the National Health Policy Conference
e. In-person meetings not attached to an AcademyHealth meeting
f. A website with webcasts of events, links to additional resources, and discussion boards

7. Please select the one mode of participation that you are most likely to use to engage with this group.
a. Audio conference that feature a guest speaker or panel
b. Audio conference with open discussion among participants
c. In-person meetings in conjunction with the Annual Research Meeting
d. In-person meeting in conjunction with the National Health Policy Conference
e. In-person meetings not attached to an AcademyHealth meeting
f. A website with webcasts of events, links to additional resources, and discussion boards

8. Which one of the following best describes your primary work role? (Please check only one.)
a. Researcher
b. Policy analyst
c. News professional
d. Policymaker or staff for a policymakers
e. Student
f. Public relations professional
g. Other; please specify:

9. Which of the following best describes your level of experience with health policy communications? (Please check only one.)
a. No experience
b. 1-3 years
c. 4-5 years
d. 6-9 years
e. More than 10 years

10. Other comments/suggestions about this group: