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Submitted URL: https://r20.rs6.net/tn.jsp?f=001L7FNQhiDL6zKSQtmsIRmG0EAI5s5_dYbAERFjH2YRnoiO_MnqQhW6_paC8vNu4juLF5gUWHaV8c-Okq7wUez...
Effective URL: https://lp.constantcontactpages.com/sv/8yZp2hV?source_id=cddc61ec-3ba0-478a-bab7-389e805ab6a6&source_type=em&c=kASPOc5N8zMJik8PeU0IY...
Submission: On January 23 via manual from IN — Scanned from DE
Effective URL: https://lp.constantcontactpages.com/sv/8yZp2hV?source_id=cddc61ec-3ba0-478a-bab7-389e805ab6a6&source_type=em&c=kASPOc5N8zMJik8PeU0IY...
Submission: On January 23 via manual from IN — Scanned from DE
Form analysis 1 forms found in the DOM
<form class="form" data-purpose="survey" data-ab-campaign-id="cc7dab4c-895c-4371-86ed-a7bf0e43e6f8" data-ab-campaign-activity-id="496c814c-a4d6-476c-b0d3-e3670669396d" data-version-id="37a065b9-6d2e-4846-a86d-965b6dc26db5"
data-document-id="d80692d2-1102-4bbf-b648-84ef40f895d5">
<fieldset>
<table class="layout layout--1-column" style="" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="column column--1 scale stack" style=" width: 100%;" align="center" valign="top">
<table class="text text--heading text--padding-vertical" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="text_content-cell content-padding-horizontal" style="text-align: center;" align="center" valign="top">
<p>District 13 Questionnaire</p>
</td>
</tr>
</tbody>
</table>
<table class="text text--question text--padding-vertical" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="text_content-cell content-padding-horizontal" style="text-align: left;" align="left" valign="top" data-purpose="survey-question">
<div class="question content-padding-horizontal" data-purpose="question-text">
<div class="question_text" data-purpose="question"> 1. What is the most important topic in healthcare to you? </div>
<div class="message" data-purpose="message"></div>
<div class="question_answer text" data-purpose="answer">
<input type="text" name="b11c9b01-0d63-49a6-a310-7801478c71f5" maxlength="50">
<div class="characterCount">
<span data-purpose="character-count">0</span>/50
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
<table class="text text--question text--padding-vertical" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="text_content-cell content-padding-horizontal" style="text-align: left;" align="left" valign="top" data-purpose="survey-question">
<div class="question content-padding-horizontal" data-purpose="question-text">
<div class="question_text" data-purpose="question"> 2. What would you like to hear/learn more about in the coming year through District CE offerings? </div>
<div class="message" data-purpose="message"></div>
<div class="question_answer text" data-purpose="answer">
<textarea type="text" name="9f2a31ee-014f-433c-bfab-1a693d9977b9" maxlength="250"></textarea>
<div class="characterCount">
<span data-purpose="character-count">0</span>/250
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
<table class="text text--question text--padding-vertical" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="text_content-cell content-padding-horizontal" style="text-align: left;" align="left" valign="top" data-purpose="survey-question">
<div class="question content-padding-horizontal" data-purpose="question-text">
<div class="question_text" data-purpose="question"> 3. Please provide suggestions on social events to be hosted by the district. </div>
<div class="message" data-purpose="message"></div>
<div class="question_answer text" data-purpose="answer">
<textarea type="text" name="20e413de-3441-4ba0-bf0f-c70d191acf25" maxlength="250"></textarea>
<div class="characterCount">
<span data-purpose="character-count">0</span>/250
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
<table class="text text--question text--padding-vertical" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="text_content-cell content-padding-horizontal" style="text-align: left;" align="left" valign="top" data-purpose="survey-question">
<div class="question content-padding-horizontal" data-purpose="question-text">
<div class="question_text" data-purpose="question"> 4. Please provide any topic suggestions and/or speaker recommendations you may have. </div>
<div class="message" data-purpose="message"></div>
<div class="question_answer text" data-purpose="answer">
<textarea type="text" name="33aedab8-4260-4c14-856b-4e24c94241dc" maxlength="250"></textarea>
<div class="characterCount">
<span data-purpose="character-count">0</span>/250
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
<table class="text text--question text--padding-vertical" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="text_content-cell content-padding-horizontal" style="text-align: left;" align="left" valign="top" data-purpose="survey-question">
<div class="question content-padding-horizontal" data-purpose="question-text">
<div class="question_text" data-purpose="question"> 5. Please provide ideas you may have on community initiatives in which the district might participate. </div>
<div class="message" data-purpose="message"></div>
<div class="question_answer text" data-purpose="answer">
<textarea type="text" name="cc6f6bdf-954d-4e53-9459-59c85b9cc779" maxlength="250"></textarea>
<div class="characterCount">
<span data-purpose="character-count">0</span>/250
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
<table class="text text--question text--padding-vertical" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="text_content-cell content-padding-horizontal" style="text-align: left;" align="left" valign="top" data-purpose="survey-question">
<div class="question content-padding-horizontal" data-purpose="question-radio">
<div class="question_text" data-purpose="question"> 6. Are you interested in providing an article or other information for the MNA newsletter in the future? </div>
<div class="message" data-purpose="message"></div>
<div class="question_answer radio" data-purpose="answer">
<input type="radio" name="2006445a-da9c-4a87-b2b9-f58992156a63" id="074be3ab-f834-4f62-9e0d-251f714b6ac8" value="Yes">
<label for="074be3ab-f834-4f62-9e0d-251f714b6ac8">Yes</label>
</div>
<div class="question_answer radio" data-purpose="answer">
<input type="radio" name="2006445a-da9c-4a87-b2b9-f58992156a63" id="2e6dd0ad-78f2-4e17-8faf-699bd2d0d97b" value="No">
<label for="2e6dd0ad-78f2-4e17-8faf-699bd2d0d97b">No</label>
</div>
</div>
</td>
</tr>
</tbody>
</table>
<table class="text text--question text--padding-vertical" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="text_content-cell content-padding-horizontal" style="text-align: left;" align="left" valign="top" data-purpose="survey-question">
<div class="question content-padding-horizontal" data-purpose="question-text">
<div class="question_text" data-purpose="question"> 6a. If you answered "Yes" to Question 6, please provide details. </div>
<div class="message" data-purpose="message"></div>
<div class="question_answer text" data-purpose="answer">
<textarea type="text" name="9e226520-ec60-4038-9626-6e8598dc1557" maxlength="250"></textarea>
<div class="characterCount">
<span data-purpose="character-count">0</span>/250
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
<table class="text text--question text--padding-vertical" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="text_content-cell content-padding-horizontal" style="text-align: left;" align="left" valign="top" data-purpose="survey-question">
<div class="question content-padding-horizontal" data-purpose="question-text">
<div class="question_text" data-purpose="question"> 7. Additional comments/questions. </div>
<div class="message" data-purpose="message"></div>
<div class="question_answer text" data-purpose="answer">
<textarea type="text" name="5bdc2f42-0451-40ab-90d8-abb3ffada853" maxlength="250"></textarea>
<div class="characterCount">
<span data-purpose="character-count">0</span>/250
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
<table class="layout layout--1-column" style="" width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td class="column column--1 scale stack" style=" width: 100%;" align="center" valign="top">
<div class="button button--padding-vertical content-padding-horizontal" style="text-align: center;">
<a data-purpose="survey-submit" class="button_link" href="#" data-trackable="true" style="">Submit Survey</a>
</div>
</td>
</tr>
</tbody>
</table>
</fieldset>
</form>Text Content
District 13 Questionnaire 1. What is the most important topic in healthcare to you? 0/50 2. What would you like to hear/learn more about in the coming year through District CE offerings? 0/250 3. Please provide suggestions on social events to be hosted by the district. 0/250 4. Please provide any topic suggestions and/or speaker recommendations you may have. 0/250 5. Please provide ideas you may have on community initiatives in which the district might participate. 0/250 6. Are you interested in providing an article or other information for the MNA newsletter in the future? Yes No 6a. If you answered "Yes" to Question 6, please provide details. 0/250 7. Additional comments/questions. 0/250 Submit Survey If you just opted in, you're consenting to receive marketing emails from: Mississippi Nurses Association, 31 Woodgreen Place, Madison, MS 39110. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact