SCAK Participation Survey

What is your Sickle Cell status?*

I have SCDI have SCTI don't have either, but I know someone who does have SCD/T.I don't have either, but I (want to) support the community.I don't know my status

What types of events are you most likely to attend?

What types of support would you need to attend a function?

Are there other supports or accommodations that you would need to attend a SCAK function?

Would you be willing to talk to us about your answers?

YesNo

If you answered no, thank you for your time. You will NOT be contacted. Please submit this form or if this is a paper copy, turn it back into one of the attendants at the SCAK booth. Thank you for taking your time to help us provide better support to the Sickle Cell Community!

If you answered YES, please continue to fill out the form so that we can contact you at a later time. Thank your filling out this form, as well as your willingness to talk with us!

Name

First NameLast Name

What is your preferred method of initial contact?

EmailPhoneText

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.