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Hybrid Meeting Initial Survey

Pain Collaborative to Advance Equitable Value-Based Solutions

This survey aims to gather information for the logistical planning of the Pain Collaborative's hybrid meeting on October 28th, 2024, at Southern California University of Health Sciences in Whittier, CA.

Thank you in advance for taking about 5 minutes to answer the following six questions.

Please complete the following questions:

Contact Information:

Name: *
Name:(Required)
Email: *
Organization:

Attendance: We have a limit of 50 people in person for this meeting and no limit virtually.

Will you be attending the meeting? *
Will you be attending the meeting?(Required)
Will anyone else from your organization be attending the meeting? *
Will anyone else from your organization be attending the meeting?(Required)
Is your organization planning to share this meeting with a targeted group from your network that would be interested in attending? *
Is your organization planning to share this meeting with a targeted group from your network that would be interested in attending?(Required)
Who from your organization should we share the communications/marketing plans with when they are ready?

In-Person Attendance:

(If you selected "Yes, in person" for the previous question, please answer the following)
Do you require any accommodations that will facilitate your full participation in this meeting? *
Do you require any accommodations that will facilitate your full participation in this meeting?(Required)
If yes, please specify. *
Do you have any dietary restrictions or preferences? *
Do you have any dietary restrictions or preferences?(Required)
If yes, please specify. *
The meeting is tentatively scheduled from 10:00 AM-3:00 PM PT on Monday, October 28th, 2024. Would you require lodging for the event? *
The meeting is tentatively scheduled from 10:00 AM-3:00 PM PT on Monday, October 28th, 2024. Would you require lodging for the event?(Required)
We are arranging a room block at hotels near the SCUHS campus. How likely are you to reserve a room? *
We are arranging a room block at hotels near the SCUHS campus. How likely are you to reserve a room?(Required)

Virtual Attendance:

(If you selected "Yes, virtually" for attendance, please answer the following)
Do you have any specific technical requirements or support needs (e.g. closed captions, etc.)? *
Do you have any specific technical requirements or support needs (e.g. closed captions, etc.)?(Required)
If yes, please specify. *

Session Preferences:

Which session topics are you most interested in? Please select your top 3 choices.*
Which session topics are you most interested in? Please select your top 3 choices.(Required)
If other, please specify.*
Which breakout sessions are you most interested in? Please select your top 2 choices.*
Which breakout sessions are you most interested in? Please select your top 2 choices.(Required)
Are there any other topics you would like to see covered, particular types of presenters, or anything else you’d like to share?*
Are there any other topics you would like to see covered, particular types of presenters, or anything else you’d like to share?(Required)
If yes, please specify.*

Feedback and Suggestions:

Do you have any suggestions or comments to improve the meeting?

Thank you for your participation! Your responses will help us in planning a successful event. Please submit your responses by August 21st, 2024.