Please list your city/county and state:

How did you find out about the HT Mid-Atlantic Regional Conference:

Have you ever attended an HTI Conference:

Yes No

How often would you attend a
Regional Conference:

Preference of Regional Conference Length:

Preferred location of next Regional Conference:

Other:

Second Choice:
Virginia Beach, VA Richmond, VA Roanoke, VA Washington DC Area Annapolis, MD Frederick, MD

Suggested workshop topics:

Suggested keynote speakers:

Suggested workshop presenters:

Would you like to have vendors present at the next conference?

Yes No

If yes, what type of products do you prefer?

Would you like to have smaller regional gatherings in your area:

Yes No

If yes, would you prefer to have smaller gatherings in addition to or instead of a large regional conference such as this one?

In addition to
Instead of

Please select the highest level of
Healing Touch taken:

1 2 (2A) 3 (2B)
4 (3A) 5 (3B) 6 (4)

Please check if you are a

Please check memberships held:

Did this web site satisfy your information needs?

Yes
No

If no, what information needs were not met?

Would you like to have a HT Mid-Atlantic Regional Chapter web site to visit concerning upcoming energy-based classes and events in your area?

Yes
No

If yes, what other information would you like this site to offer?

Would you like monthly email alerts on upcoming energy-based classes and events?

Yes No

If yes, please enter your email address or send email to GISAofVA@aol.com if you wish monthly regional email alerts.