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DO YOU PLAN TO ATTEND THIS CONFERENCE? (check one) ............. Yes ........ Probably ............ No (Daycare services will be provided for those who must bring their children). IN WHAT LANGUAGE DO YOU PREFER THIS CONFERENCE BE CONDUCTED? ......... Ukrainian ......... English P E R S O N A L D A T A AGE ......... Under 21 ........22-30 ........31-45 ........ 45-55 ........ Over 55 MARITAL STATUS ......... Single ..........Married ......... Divorced ......... Widowed CHILDREN ......... No children ......... Pre-school ......... Grades 1-12 .......... College ......... Empty nest WORK ......... Full-time ......... Part-time ......... Not currently working outside home .................. What Field (business, teaching, etc.) EDUCATIONAL BACKGROUND ........ Liberal arts ......... Sciences ......... Business ..........Other ......... Specific Field SOURCE OF INFORMATION ON UKRAINIAN EVENTS ......... Ukrainian-language ......... English-language ......... ’’Our Life” ......... Church ......... Friends, ’’Svoboda” ’’Weekly” (’’Nashe Zhyttia”) relatives ORGANIZATIONS .... Number of Ukrainian organizations to which you belong. I ......... Number of American organizations to which you belong. THANK YOU FOR FILLING OUT BOTH SIDES OF THIS QUESTIONNAIRE AS OUR INTENTION IS TO CONTACT AS MANY WOMEN AS POSSIBLE, WE ENCOURAGE YOU TO DISTRIBUTE COPIES OF THIS QUESTIONNAIRE TO INTERESTED INDIVIDUALS. IF YOU KNOW OF SOMEONE WHO SHOULD BE ON OUR MAILING LIST, PLEASE ATTACH A LIST OF NAMES ( IN ENGLISH), ADDRESSES (INCLUDE ZIP CODE) ________ AND PHONE NUMBERS (INCLUDE AREA CODE).________________________________________ Your Name.............................................................................................................................................................. Address.................................................................................................................................................................... City...................................... .......... State...............................................Zip Code ............................................... Telephone............................ S E N D T O : U K R A IN IA N W O M E N ’S C O N F E R E N C E O R G A N IZ IN G C O M M IT T E E C /O U N W L A , 108 S E C O N D A V E N U E , N E W Y O R K , N Y 10003 ’’НАШЕ ЖИТТЯ”, СІЧЕНЬ 1982 26 Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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