Northwest Immunization Conference 2020
Attendee Registration
NAME
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CREDENTIALS
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POSITION
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EMAIL
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** Address will only be used to send conference materials, swag and prizes **
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CITY
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STATE / PROVINCE
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ADDRESS TYPE
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As an attendee, which of the following best describes your role?
Community Member
State / County Health Department
Healthcare Organizations (clinical)
Health Management / Leadership
Research & Informatics
Public Health Agency
Student / Faculty
Vaccine Manufacturer
Health Insurance
Other
As an attendee, which of the following best describes your role? (check all that apply)
*
Community Member
State / County Health Department
Healthcare Organizations
Public Health Agency
Academia / University
Vaccine Manufacturer
Management / Leadership
Health Promotion & Education
Health Advocacy & Policy
Research & Informatics
Clinical Personnel
Student / Faculty
Other
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IMMUNIZE OREGON SURVEY
As we strive to improve immunization education, training, and resources, we ask that attendees complete this short quesionnaire to provide insight into how we can support you! All answers will be kept anonymous and only used to identify areas Immunize Oregon should focus efforts.
Have you attended the Northwest Immunization Conference before?
Yes
No
I trust my health care provider to honestly tell me about the risks and benefits of vaccines?
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Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
My health care provider will have the vaccine I need, when I need it
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Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
Most people I know are vaccinated and/or are getting their children vaccinated.
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Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
The benefits of vaccines outweigh the risks
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Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
Routine childhood vaccines are safe
*
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
The 3 most important sources I turn to for vaccine information
*
ADDITIONAL INFORMATION
Use this field for any comments, concerns, or specific requests so we can support you!
Are you attending the HPV Prevention Alliance Meeting??
*
Yes
No
Maybe
Need more info before deciding
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