© 2008 GWC Inc., 530 Falling Springs Road,  Cahokia, IL 62206    1  -  8  0  0   -  8  5  1   -  5  4  0  6     Fax: 618-337-7880
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Complete our Online Survey to be Automatically Entered to Win!


Your client education and staff training needs are important to us. To assist us in producing current materials that are relevant to your needs we need your help. Please take just a few minutes and complete the following questionnaire. Upon completion of this questionnaire, you will be automatically entered to win a free video. A free video is given away each month! If you are one of the lucky participants to be selected as a winner, you will be notified and your name will be posted here on the GWC website.

Tell Us About Yourself:
Where do you work?
Your Name
Title
Address
City
State
Zip Code
Day Phone
Fax
E-mail

Where do you work?

Community      Corrections
Hospital
Pre-Release Program
Probation / Parole
Treatment Program
Other:
Federal Prison
Juvenile Program
Dept.of Corrections
Drug Court
DUI Program
Halfway House

What type of clients do you work with?

Male

 10-20%  21-40% 41-60% 61-80% 81-100%

Female

10-20% 21-40% 41-60% 61-80% 81-100%

Juvenile

10-20% 21-40% 41-60% 61-80% 81-100%

How do you prefer to be contacted to preview or purchase education and training materials?

 Phone
Fax
E-mail
Direct Mail
Any combination of the above
Once I receive written materials (in any form) I will initiate contact if interested.

Education & Training Materials:
 A.  What kind of materials do you currently use for staff training?

VHS Tapes
DVDs
Books
 Audio Cassettes
 CD-ROM
 Workbooks		 Distance Learning
 Workshops
 Attend Conferences
Other:

B.  What kind of materials do you currently use for client education?  
VHS Tapes
DVDs
Books
 Audio Cassettes
 CD-ROM
 Workbooks		 Distance Learning
 Other:

C.  What video topics are you interested in or see an immediate need for?

ADHD
Addiction Disease
Relapse Prevention
Conflict Resolution
Cultural Diversity
Co-Occurring Disorders
Domestic Violence
Eating Disorders
Pre-Release Issues
Spirituality
Marijuana
Alcohol
Cocaine		 Heroin
Methamphetamine
Family Issues
Juvenile Issues
Parenting Skills
Anti Social Behaviors
HIV
Mental Health
Sexual Abuse
Relationships
Hispanic Issues
Native-American Culture
Gambling
Security Threat Groups / Gangs
Other

D.  General Questions

Preferred Video/DVD Length: 

Prefer video Programs which Include:


 
  

E.  General Comments

I would like to receive information about future workshops & conferences via mail or e-mail.
Send me a catalog.

You will receive instant confirmation of your survey submission.
For more information, call 800-851-5406
FAX to 618-337-7880, or E-mail: info@gwcinc.com

General Rules and Notes
Only 1 entry per person every 30 calendar days.
Surveys must be completely filled out and be submitted unencrypted.
Drawings are done on or near the 1st of every calendar month.
Prize videos are selected from the GWC prize video list as determined by management.
No survey info. shall be shared, sold or transferred with outside vendors.



GWC, Inc.©
P.O. Box 5023
530 Falling Springs Road
Cahokia, IL 62206
Phone: (800) 851-5406 or (618) 337-9300
Fax: 618-337-7880
E-Mail: customerservice@gwcinc.com
 
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