Organizational Endorsement of the Louisville Charter
This form is for ORGANIZATIONS that want to add their organization's name as a public endorser of The Louisville Charter for Safer Chemicals.

If you want to add your name as an Individual endorser of the Louisville Charter, please use this form instead:

All organizational endorsements will be publicly listed on Coming Clean's web site, and used publicly in other ways. Please fill in the information on the form EXACTLY as you want it to appear on public pages and documents.
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The information in the first two questions below (organization name and location) will be listed publicly.
Organization Name (exactly as you want it to appear publicly) *
Location of the Organization (or it's primary location or headquarters) as you would like it listed publicly. Please include CITY and STATE. *
The remaining questions (below this point) are for internal use only. These responses will NOT be shared publicly.
Scope of the Organization's Work (choose one) *
Contact Person Name *
Email Address for Contact Person *
Phone Number for Contact Person
Web Site for the Organization
Please check boxes below if you would like to:
Is there anything else you'd like us to know?
Confirmation of Authority to Endorse on Behalf of the Organization *
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