Name:

Email:

Center (select one)

ECMO
MIDMO
NEMO
NWMO
SEMO
SWMO
WCMO

Date of Workshop (mm/dd/yy):

Title of Workshop:

Location:

What new information or skills did you learn about this workshop: List at least 3 things

How will you use the information or skills that you learned from this workshop?

What did you enjoy about the workshop? Provide at least 1 example.

Name 2 interesting things you leaned from this workshop.

What questions do you still have about this topic?

Overall, I would rate the workshop (select one):

Great - 1
2
3
4
Poor - 5