Old Parties for revision

HOUSE PARTY FEEDBACK FORM

      FIRST and foremost – THANK YOU for hosting a house party. It is a wonderful way to spread the word about the need for health care reform, Health Care as a Human Right, and how we will achieve universal health care in Oregon and the US.

      Your name:__________________________

      Address:_________________________________ City_______________ Zipcode__________

      Phone:_____________________ Email:____________________

      Date of house party:____________________

      Number of participants:______

      Donations received (including pledges): $________

      What was the best part of your party?

      _____________________________________________________________________________

      _____________________________________________________________________________

      _____________________________________________________________________________

      Next time, what would you do differently?

      _____________________________________________________________________________

      _____________________________________________________________________________

      _______________________________________________________________________

      ______

      Are you willing to do an “encore” with another group of friends sometime in the next six months? Yes___ No___

      Return this form to:

      HCAO

      316 SW Washington

      Corvallis, OR 97333