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Instructions: Use your mouse to click on the circle below your response. A dot will appear to indicate your choice. You may change this by clicking on a different circle for that question. Please answer every question. If a question does not apply, or if you are unable to provide feedback for an item, select N/A for Not Applicable
Use a scale from “1” to “6” where 1 means you are “Extremely Satisfied” and a 6 means you are “Not at all Satisfied”.
 
 
1 2 3 4 5 6 N/A
1. How satisfied are you overall with your relationship with Organization XYZ?
2. How satisfied are you with Organization XYZ’s website?
 
 
 
3. How often do you visit Organization XYZ’s website?
 
At least Once a Day
 
2-3 Times a Week
 
Once a Week
 
2-3 Times a Month
 
Once a Month
 
Less than Once a Month
 
Never
 
 
 
4.How many of Organization XYZ events did you attend in the past 6 months?
 
10 or more events
 
5-9 events
 
2-4 events
 
1 event
 
Did not attend any events in the past 6 months
 
 
Use a scale from “1” to “6” where 1 means “Extremely Valuable” and a 6 means “Not at all Valuable”.
1 2 3 4 5 6 N/A
5.How valuable were the events you attended?
 
 
 
6. Do you plan on renewing your membership to Organization XYZ in 2011?
 
Yes
 
No
 
Don’t Know Yet
 
 
 

7. Which other organizations are you a member of? Check all that apply:
 
Org 1
 
Org 2
 
Org 3
 
Org 4
 
Org 5
 
Other (please specify):

 
 
Use a scale from “1” to “6” where 1 means “Extremely Likely” and a 6 means “Not at all Likely”.
1 2 3 4 5 6 N/A
8. How likely are you to recommend the Organization to a colleague or business acquaintance?
 
 
Please let us know you have any comments or suggestions for Organization XYZ:
   
 
 
 
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