Summit Questionnaire

Please briefly provide the following information:

Your Name*

First Name Last Name

Country*

Your Country

State

Province

Your Province

Your email address*

Your email address

Are you a member of a group that is already working to oppose CSE?

Are you a member of a group that is already working to oppose CSE?*

Yes
No

Name of group already opposing CSE

Name of group

Website of group already opposing CSE

Group Website / Facebook Page

Are you a member of a group that would like to become active in this effort?

Are you a member of a group that would like to become active in this effort?*

Yes
No

Name of new group

Name of your group

Website of new group

Group Website / Facebook Page

Would you like to be put in contact with others in your area who are working to oppose CSE?

Yes
No

Do you know any other group or groups in your country, state or province that are actively working to oppose CSE?

Do you know any other group or groups in your country, state or province that are actively working to oppose CSE?*

Yes
No

If yes, please provide the names and contact information or website of the group(s).

Please tell us about your involvement in any efforts to stop CSE, or if you have not yet been involved, tell us why you are interested in helping and anything else you think would be helpful for us to know.

Additional Comments or concerns

CSE QUESTIONNAIRE