Gowanus Canal Community Advisory Group Membership Application Form
The mission of the Gowanus Canal Community Advisory Group is to be a forum for dialogue between representatives of all segments of the community about the federal Superfund clean-up of the Gowanus Canal and other related issues of concern to the community.

If you are interested in joining the Community Advisory Group (CAG), we welcome your application. Please fill out the form below. The CAG has organizational and at-large members from the community. CAG members are expected to attend at least half of all monthly meetings in a year and join one of the committees.

Please familiarize yourself with the requirements of CAG membership by reviewing the CAG’s Charter, here: http://bit.ly/CAGCharter.
Your Name *
Today's Date *
MM
/
DD
/
YYYY
Home Address *
City *
State *
Zip Code *
Telephone Number *
Email Address *
Employer Name & Address (if applicable)
Work Phone / Extension
Which local Civic Organizations are you affiliated with, if any, and in what capacity?
What special skills or capabilities are you willing to contribute to the CAG?
As a member of the CAG, will you represent... *
If an organization, which one?
For organizational representatives, what mechanism do you have to disseminate information to your members?
Please summarize your organization's mission statement.
How did you hear or learn about the CAG? *
What is it about the CAG's mission that motivates you at this point in time to join and what would you like to contribute to its stated mission? *
All CAG members are required to participate on at least one committee. Please choose one or more from our list of standing committees. *
Required
Is there anything else you would like us to know about you?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy