Promotional Giveaway Campaign Feedback Form

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Let us know how this section supports your needs AND what else we can add to support you even more.

Promotional Book Campaign Feedback Form

We'd like to express our gratitude for the time and energy you invested in sharing NVC. The continued growth of the greater NVC community is very important to us.

Please complete the survey below as best you can. When complete, click the SUBMIT button at the bottom.

INFORMATION ABOUT YOU:
	*Required Fields (if available)
NVC organization affiliate (if any)
*First Name
*Last Name
*Email
*Address
*City
*State
*Zip
*Country
*Phone

I Am A


INFORMATION ABOUT YOUR CONTACT:
*May we contact this individual in the future?	Yes No
Organization Name
*First Name
*Last Name
*Title
*Email
*Address
*City
*State
*Zip
*Country
*Phone


Organization's Areas of Focus (Please check all that apply)
	Anger Management	Business
	Children/Youth	Communication
	Education	Healing/ Reconciliation
	Marriage/Family	Mediation/Conflict Resolution
	Prisons	Recovery
	Social Transformation	Violence
	Other: explain in comments

Brief description of the meeting or presentation you led:
Please provide a brief description of the outcome experienced so far:
Comments:

Did any promotional partnerships or training opportunities develop as a result of this conversation/presentation?	Yes No

Do you anticipate working further with this contact?	Yes No

Would you like us to follow up on this contact on your behalf?	Yes No

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"Self judgments, like all judgments, are tragic expressions of unmet needs." -Marshall B. Rosenberg, Ph.D.