Please give some thought each question in this survey. Hearing from you will help us decide if it is feasible to continue with this campaign. We must work as a team and the more nurses involved, the bigger impact we make with anyone we must deal with. The information will be very helpful in making our reorganization more effective.

If you can fill this out online, please do. Otherwise, print it out and mail it to me at
672 Massachusetts Ave., Acton MA 01720-2233

Thank you.

Debbie McKown

Survey and Information Form:

1. Name:

2. Address:(street, city, zip)

3. Phone number:

4. Fax number:

5. Email address:

6. Are you getting a reduced pension for your part time work at a VA? yes no

7. Who are your senators and representative in Washington?

How have you contacted them? email fax telephone office visit post card letter other

Which has gotten the most positive response?

What exactly has been your experience when you have contacted your legislator's office?

8. Are you a veteran yourself, or have a family member who is? yes no

What vets' organizations are you, or they, members of?

9. What nurses' union did your hospital have? Are you a member now? (There are

some unions that have retired members and the dues are very inexpensive.)

10. Are you a NARFE member? (if not, why not?) yes or no

11. Do you participate in your local NARFE chapter? (if not, why not?)

12. Do you belong to any organizations which are proactive in legislative matters or would be
willing to help you in any way?

13. Which VA(s) did you work at?

14. Have you looked for other retired nurses who are effected? yes no

15. If you find them, will you make sure that they contact us or tell us to contact them? yes no

16. Do you check the website(www.oocities.org/varnpension) for news about the campaign?
yes no How often? If not, why not?

17. To what degree are you willing/able to work on this campaign?

18. What would you be willing to do to help?

19. What suggestions or feedback can you make about this campaign?

20. What prevents you, (if it has), from working on this campaign?

21. If you haven't been participating, what would help you be more active?

22. Can you use email easily? yes no Can you access and use the internet? What problems do you have?

23. Do you have any questions about the campaign- past, present, or future? yes no

24. Are you affected by the GPO- yes__ no______________WEP- yes______ no_______

25. Are you aware that if you notify me to call you, I will and it will not cost you anything? Email me to call you, or call me and I'll call you back. 978-263-4443 yes no

26. If there is anything you would like to add, please do!

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