LAAAP - Louisiana Chapter, American Academy of Pediatrics

Member Email and Internet Survey

Name
Office Phone
Office FAX
Email ( personal / professional)
Web Site ( personal / professional)
CHECK ALL THOSE THAT APPLY
Do you have Interent access?	Home Office None
How often do you use the Internet?	1-2x a day every other day 1-2x a week Other:
For what purpose do you primarily use the Internet?	Research Business Pleasure
How often do you check your email account?	1-2x a day every other day 1-2x a week Other:
I am an LAAAP member and wish to obtain the Members Only password.

Once processed, we will send you the password to the www.laaap.org, Members Only Section. Thank you for completing the survey!