JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Kick Your Plastic Habit - Take the Pledge!
"I pledge to reduce my 'plastic footprint' by following the '12 Steps to Kick Your Plastic Habit' for a healthier world."
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Pledge Your Support!
Name
*
Your answer
Email Address
*
Your answer
Phone Number
Your answer
City, State, Zip Code
Your answer
What habit(s) are you pledging to kick?
Plastic bags
Straws
Utensils
Water bottles
Microbeads
Excess packaging
Other:
Would you like to be added to our email list? We will provide you with information about upcoming events and tips to help break the plastic addiction.
Yes
No
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report