Floridians Against Fracking Coalition Commitment Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Title

Name *

Organization *

If none, write 'Independent'

Address

City *

Zip *

Phone *

Email *

Confirm Email *

Share Logo (Y/N) *

How or from whom I learned about the Coalition *

What I or our organization brings to the table *

Membership level, including numbers, sector addressed, locations of organization bases around state, contacts or relationships developed with legislators, what you can do for the coalition/ how you plan to be involved

I would like to be added to the 'Activist' group email, in addition to the Coalition email *

The Coalition email listserv gets a couple of emails per day, and is moderated to ensure you only get the critical emails. The Activist email listserv is minimally moderated, and includes individuals who intend to be very active volunteers and want to swap ideas for tactics. It is a heavy volume of emails per day.

Yes

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.