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Please Tell Us About Your Group
To better help us in developing a proposal for your charter, please give us a little information about your organization and about your interests in future educational programs. This information will help us respond to your inquiry more quickly and efficiently. Please answer all questions.

1. Organization Information

Organization Name

Mailing Address 

City
State
Zipcode
Total Membership:
Age Range of Members:
Do you have a current mailing list to send members information? Yes   No
If yes, how large is your mailing list?
For what percentage of your total membership do you have email addresses?

2. Primary Contact Information

Individual's Name
Telephone Number

Mailing Address 

City
State
Zipcode

 Email Address

3. Please share your organization’s mission and the geographic scope of your current activities.

4. Website’s address:
(please tell us your website’s Internet address)

5. Please indicate the number(s) for programs in which you have an interest. If uncertain, you can search for program ideas on our website: www.roadscholar.org. For charter programs, we will arrange a special date(s) for your organization so there is no need to be concerned about finding a specific date in our catalogs.

(please list one or more program numbers in the order of most to least interest)

6. Number of participants you expect to attend this charter program
Between 10 and 20 people
Between 20 and 30 people
Between 30 and 50 people
More than 50 people

7. Please tell us approximately how many members would receive marketing information for this charter program.


8. How would you expect to notify your members about this charter program? Please check all that apply.
Email messages
Member newsletter
Publication
Other

9. If you have any questions, or if there is anything else that you would like to share regarding your interest in charter programs or your organization, please use the space below. Thank you.


We will reply to you within two (2) business days after receipt of the information in this questionnaire.

 
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