Product Respondent Roster

Please duplicate this form and complete all of the information below for each respondent who will fill out a product questionnaire. Please fax the form(s) to Sarah Bennett at 301-517-4134 by September 14, 1998. If you have any questions please call Sarah Bennett at 301-610-5565 or Denise Glover at 301-251-2269.

NAME__________________________________
ADDRESS_______________________________
________________________________________
________________________________________
PHONE_________________________________
FAX____________________________________
E-MAIL_________________________________
AGENCY(include sub-agency)
________________________________________
PRODUCT_______________________________
________________________________________

 NAME__________________________________
ADDRESS_______________________________
________________________________________
________________________________________
PHONE_________________________________
FAX____________________________________
E-MAIL_________________________________
AGENCY(include sub-agency)
________________________________________
PRODUCT_______________________________
________________________________________
NAME__________________________________
ADDRESS_______________________________
________________________________________
________________________________________
PHONE_________________________________
FAX____________________________________
E-MAIL_________________________________
AGENCY(include sub-agency)
________________________________________
PRODUCT_______________________________
________________________________________

 NAME__________________________________
ADDRESS_______________________________
________________________________________
________________________________________
PHONE_________________________________
FAX____________________________________
E-MAIL_________________________________
AGENCY(include sub-agency)
________________________________________
PRODUCT_______________________________
________________________________________
NAME__________________________________
ADDRESS_______________________________
________________________________________
________________________________________
PHONE_________________________________
FAX____________________________________
E-MAIL_________________________________
AGENCY(include sub-agency)
________________________________________
PRODUCT_______________________________
________________________________________

 NAME__________________________________
ADDRESS_______________________________
________________________________________
________________________________________
PHONE_________________________________
FAX____________________________________
E-MAIL_________________________________
AGENCY(include sub-agency)
________________________________________
PRODUCT_______________________________
________________________________________

Sarah Bennett: bennets1@westat.com
Denise Glover: gloverd1@westat.com

Agencies can send both their agency representatives' information (those who will attend the meeting) and the product respondent list to us in the text of an e-mail message or as a text only file, if sent as an enclosure, to either one of the above addresses.