Please Select All of Your Volunteer Interests

Please select all of your volunteer interests: S o c i ety V olunteers S c h o o l & Y o u t h □ Tell me more! Students collect change during a 3- □ Ambassador week period □ Marketing Visits □ School Assembly □ Community Volunteer Events/Health Fairs □ School Ambassador Please select your □ Tell me more! availability: □ Advocacy – receive email Frequency notices to take action on T e a m I n T ra i n i ng □ Weekly public policy initiatives Endurance Sports Training □ Monthly Program □ Ongoing Basis □ Patient Services □ Set up or break down □ As-Needed Committee – group of □ Registration/Check in □ Water stops volunteers assisting with □ Share your story Time of Day promoting LLS programs □ Tell me more! □ Mornings and services. Attend □ Afternoons regular meetings and Light T he N i g h t □ Evenings execute tasks. Community Fundraising Walk □ Anytime! □ Hand out materials to □ Office Volunteers – Survivors Day of Week address and stuff □ Register new folks to be □ Monday envelopes, return calls, etc. Advocates □ Tuesday Set up or □ Night of Event: □ Wednesday break down □ Thursday □ □ Friday ReNgigishttrati ofo Event:n/Check in □ Saturday □ Any da

In order to improve our education programs, it is important that we learn a little about you and get your feedback on today’s program. Thank you in advance for completing this evaluation!

1. I am attending today as a (select all that apply):  Cancer patient/survivor  Friend/family member  Caregiver of a patient

 Healthcare professional (HCP): Nurse ___ Social Worker ___ Other HCP (Please specify) ______

 Other (Please specify): ______

2. My age is:  < 18 18-30  31-40  41-49  50-64  65-79  >80 3. My gender is:  Female  Male  Other

4. My race is (select all that apply):  White or Caucasian  Black or African American  Asian

 American Indian or Alaska Native  Native Hawaiian or Pacific Islander

 Other (please specify): ______

5. Do you consider yourself Hispanic/Latino? Yes No

6. What is your ZIP code? ______

7. How did you hear about this conference (check all that apply)?

 Email or printed invitation from LLS  LLS website  LLS program or event

 Ad in a local paper  A friend/family member/colleague

 At a healthcare center/doctor’s office (Please specify):______

 At another organization (Please specify):______ Other (Please specify): ______

8. Have you been diagnosed with a blood cancer? Yes No

8a. If no, please tell us the type of cancer with which you were diagnosed: ______

8b: If yes, please tell us the type of blood cancer (check all that apply):

 Acute myeloid leukemia (AML)  Acute lymphoblastic leukemia (ALL) Multiple Myeloma

 Chronic myeloid leukemia (CML)  Chronic lymphocytic leukemia (CLL)

 Non-Hodgkin lymphoma (NHL)  Hodgkin lymphoma (HL)  Myelodysplastic syndromes (MDS)

Myeloproliferative neoplasms (MPN) (Polycythemia Vera, Essential Thrombocythemia, Myelofibrosis)

 Other (Please specify):______

9. How long has it been since your (or the patient’s/survivor’s) diagnosis?

 Less than 30 days  1-3 months  4-7 months  8-11 months  1-3 years  4-7 years  8-10 years 11-20 years  More than 20 years 10. Are you (or the patient/survivor) presently in treatment? Yes No

11. Is/was your treatment (or the patient/survivor’s treatment) provided as part of a clinical trial? Yes No

12. To what extent do you agree or disagree with the following statements?

Strongly Disagree Disagree Agree

I have new knowledge about LLS and blood 1 2 3 cancer survivorship. 1 2 I have new information that will be helpful in discussing treatment with 1 2 the healthcare team. I have gained knowledge that will help in managing treatment side 1 2 effects. I better understand the importance of having a treatment summary to 1 2 plan for ongoing care. I gained knowledge that will help manage ongoing survivorship 1 2 issues. I better understand how to access local resources and cancer centers 1 2 that provide comprehensive I learned more about LLS resources and programs, 1 2 and how to access them. I plan to contact LLS to obtain 1 2 additional information.

13. To what extent do you agree or disagree with the following statements?

Strongly Ag Strongly Dr. Ian DeRoock: Update of Blood Cancer Treatments Disagree Disagree ree Agree The material presented was useful. 1 2 3 4

Speaker was responsive to audience questions. 1 2 3 4

Speaker’s style was effective overall. 1 2 3 4 Kirby Consier and Frank Nagy: AZ Cancer Control Plan Strongly & Advocacy/Government Affairs Strongly DisagreeAgree Agree The material presented was useful. 1 2 3 4

Speaker’s style was effective overall. 1 2 3 4 Strongl A Strongly Susan Leigh: Survivorship Care Plans y Disagree gree Agree The material presented was useful. 1 2 3 4

Speaker’s style was effective overall. 1 2 3 4

14. Have you participated in any other in-person or online education programs or conferences organized by LLS?

Yes No

Please provide any additional feedback you may have about this program:

______

Again, thank you for volunteering for The Leukemia and Lymphoma Society!

Your time and dedication is much appreciated!