Survey - 2013 StrokeSmart(TM) Renewal - National Stroke Association

Renew Your Subscription

Current StrokeSmart Cover Don’t miss out on the next issue! Sign up now for a free renewal of your StrokeSmart magazine subscription to continue receiving this premier resource for the stroke community. Renew now by completing the form below or calling 1-800-STROKES.

1.

Please provide us with the following information. *= Required field

*

Name:

Title	First Required	Middle Required	Last Required	Suffix

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Country: Required

Sign up to Stay Informed about stroke and National Stroke Association

2.

Question - Not Required - If the address you gave is a business, enter name of the business:

*3.

Question - Required - I am interested in receiving StrokeSmart because:

If you answered "Healthcare Professional" above, please describe your profession and enter your credentials below. Otherwise, skip to question 6.

4.

Question - Not Required - Healthcare professional description:

*5.

Question - Required - My age group is:

*6.

Question - Required - The type of stroke I have had is:

*7.

Question - Required - Number of strokes I have had:

*8.

Question - Required - Gender

*9.

Question - Required - Your ethnic group:

10.

Question - Not Required - In order to help us improve our renewal process, please tell us why you didn't renew sooner.
Please make between 1 and 3 selections from the choices below.

	I just kept forgetting to renew
	I don't remember receiving a renewal notice of any kind
	I didn't understand the renewal notice
	I thought I did respond via email
	I thought I did respond via telephone
	I thought I did respond via postcard
	I recently moved and this is a new address

You will receive an email confirmation of your subscription within an hour after you click on the Subscribe Now button below. If you do not receive your confirmation please try again or call National Stroke Association at 1(800) 787-6537.