Submission Form: The No Fossil Fuel Money Pledge
The Pledge: I pledge to not take contributions from the oil, gas, and coal industry and instead prioritize the health of our families, climate, and democracy over fossil fuel industry profits.

Taking the pledge means that a candidate’s campaign will adopt a policy to not knowingly accept any contributions over $200 from the PACs or executives of fossil fuel companies — companies whose primary business is the extraction, processing, distribution, or sale of oil, gas, or coal. We will provide a list of these companies upon request.

To take the No Fossil Fuel Money Pledge:

1. Create a sharable graphic that includes your name, the seat you're running for, and the text of the pledge. We recommend using a photo of yourself and adding your signature.
2. Post the graphic on your website or social media with the hashtag #nofossilfuelmoney
3. Fill out this form below to notify the No Fossil Fuel Money Coalition.

Examples of graphics: https://www.pinterest.com/climatebrad/nofossilfuelmoney-pledge-takers/

If you have any questions, please send an email to pledge@nofossilfuelmoney.org.

You can find more information about the pledge here: http://nofossilfuelmoney.org/

Candidate Information
Candidate Name
Your answer
Office Sought
Your answer
Candidate Party Affiliation
Your answer
Current Office Held (if any)
Your answer
Primary Date (if any)
Your answer
General Election Date
Your answer
Contact Information
Campaign Contact: Name & Title
Your answer
Campaign Contact: Email Address
Your answer
Campaign Contact: Phone Number
Your answer
Campaign Facebook Account URL
Your answer
Campaign Twitter Account
Your answer
Campaign Website URL
Your answer
Do we have permission to use a headshot or similar image from your campaign website on our website? To be consider a pledge signer, the answer must be "Yes."
***Pledge Verification***
To verify that the candidate or elected has signed the pledge, please include a link where the coalition can verify that the candidate has publicly taken the pledge - i.e. a post featuring the pledge language on an official campaign website or social media account. One easy way to do this is to print out the following pledge and tweet a picture of you physically signing it: https://goo.gl/XiKbu2. You may also email a signed copy of the pledge to pledge@nofossilfuelmoney.org.
Your answer
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