Request edit access
#StopSuperSpeeders: Organization Response Form
Thank you for your willingness to sign-on in support of the New York State Speed Limiters for Repeat Offenders coalition. You can see the language of the letter and current list of signers, as well as the bill briefing document, FAQ, and more here.

You must be authorized to add your organization's name. Note that only the organization/elected name will appear on our materials publicly. All other contact information is so that we can follow-up with you, and will not be shared.  
Sign in to Google to save your progress. Learn more
Organization or Name of Elected Official/Dignitary
(as you wish it to appear on the list of supporters being shared with elected officials and others)
 *
First Name *
Last Name *
Your Title/Role in the Organization
 *
Email Address
 *
Phone Number *
Mailing Address *
What kind of area do you/your organization represent?
 *
What specific area do you represent?
 *
Can we also add you as a member of the New York State Safe Streets Coalition that fights for ISA and other street safety measures? You can see a list of the current legislative priorities here.
 *
Other suggestions or questions?
Other Potential Supporters: Who else do you know that might want to sign on? Please share this form with them!  And if you provide their name, organization and contact information, we will follow up.
 *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Transportation Alternatives.

Does this form look suspicious? Report

Google Forms