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<font face="Garamond" color="#0066CC" size="5"><u><b>E M E R G E N C Y P R E P A R A T I O N<br>A N D R E S P O N S E</b></u></font>
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<b><font face="Garamond" color="#0066CC" size="4">Guerin Associates Inc.</font></b>
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<td><b><font size="2" face="arial">SURVEY QUESTIONS</font></b></td>
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<tr><td width="17%" align="left">Name:</td><td align="left"><input type="text" name="realname"></td></tr>
<tr><td width="17%" align="left">Company:</td><td align="left"><input type="text" name="company"></td></tr>
<tr><td width="17%" align="left">Title:</td><td align="left"><input type="text" name="title"></td></tr>
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1. Would you be interested in sharing information among peer companies and facilities in a study of Emergency Preparation and Response?
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Yes<input type="radio" name="Question1" value="yes">No<input type="radio" name="Question1" value="no">
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2. Would you like to attend a workshop to discuss results with others in person?
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3. Would you be willing to host such a session at your facility?
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4. Would you be interested in a follow-up consortium study, funded by participants, to compare detailed operational data in areas of greatest group interest?
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<td><b><font size="2" face="arial">THANK YOU</font></b><p><font size="2" face="arial">
Guerin Associates would like to thank you for participating in this project. We'll contact you with further information as results are developed.
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