National Multiple Sclerosis Society

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1. Please complete the following:

Total Number of Responses
32

2. What's your connection to MS?

Value	Count	Percent
I have MS	20	62.5
Relative: Parent of person with MS	3	9.4
Relative: Child of person with MS	3	9.4
Other	2	6.3
Relative: Other	2	6.3
I have a Friend or Co-worker with MS	1	3.1
Relative: Sibling of person with MS	1	3.1

3. If you have MS, when were you diagnosed?

4. Are you a veteran living with MS?

5. If you are a veteran living with MS, tell us when and where you served (if deployed overseas).

6. Have any of these issues recently affected you? (Check all that apply)

Total Number of Responses 32

Value	Count	Percent
User Provided No Response	16	50.0
Difficulty paying for high MS drug co-pays	10	31.3
Abusive debt collection practices	6	18.8
Problems with accessibility in my community	5	15.6
Other	5	15.6
Problems obtaining necessary prescription drugs	4	12.5
Difficulty finding accessible or affordable housing	3	9.4
Repeated ongoing problems with power mobility equipment	1	3.1

7. Provide examples of how these or other issues affect you and/or your family.

8. How would you like to make a difference? (Check all that apply)

Total Number of Responses 32

Value	Count	Percent
Receive emails about MS issues and ways to take action	28	87.5
Share my story with my elected official and the MS Society	20	62.5
Research opportunities to meet with my legislator in my district	18	56.3
Attend a rally at the State Capitol	14	43.8
Be an activist leader in my district and work closely with the MS Society to make changes	14	43.8
Raise awareness about accessibility in my community	9	28.1

9. Tell us about any personal connections you have with local, state or federal officials, or someone at a government agency.

10. Is there anything else you'd like to add about your interest in advocacy or the issues that affect you?