December 11, 2002 Coordinator: Dick Roth Speakers: Ginny, Mary, Phil, Erica, Margaret


1. Estimate how much you can Drink and still Drive Safely? _________________________

2. Have any of your friends or family been killed or injured in a DWI crash?     Yes      No
Comments:
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3. What impact has this presentation had on your views about DWI?
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4. Will you be less likely to drive after drinking as a result of this Panel?    Yes    NO

Please Comment:_________________________________________________________
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5. What did you like most and dislike most about this Victim Impact Panel?
Liked Most:______________________________________________________________

Disliked Most:____________________________________________________________

6. Do you have any Suggestions for Improving Victim Impact Panels:
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7. Optional: Would you be willing to be a speaker at Victim Impact Panels? Yes No
If yes, please print your name and phone number: _________________________________

DWI VIP 1 Revised 6/5 /02