Piedmont and Coastal NC Clean Communities Coalition Stakeholder Sign-Up Form

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This form will enroll your organization in the Piedmont and Coastal North Carolina Clean Communities Coalition as a stakeholder. To join our coalition as a stakeholder, you must be a public agency or private organization that operates or has customers within eastern North Carolina or the Piedmont Triad regions and be committed to reducing your organization's use of petroleum and improving the sustainability of your fleet through reducing transportation-related emissions.

Information about the U.S. Department of Energy's Clean Cities Program can be found at: www.cleancities.energy.gov. More information about the North Carolina Clean Energy Technology Center can be found at: www.nccleantech.ncsu.edu.

Email *

First name *

Last name *

Title

Organization *

Office Phone

Cell Phone

Address *

City *

County

Does the North Carolina Clean Energy Technology Center Clean Transportation team have permission to add your businesses/organizations name to the Piedmont and Coastal NC Clean Communities coalition sign on letter as a supporter? *

Yes

Maybe (please give feedback below)

Additional Comments or Concerns

Please check the actions your organization/business intends to do in support of the Piedmont and Coastal NC Clean Communities coalition. This is not a legally binding commitment but rather an indication of interest. *

My organization/business will attend quarterly stakeholder meetings either online or in person, vehicle demonstrations, ride and drives, conferences, workshops and or webinars on topics related to sustainable fleet management.

My organization/business commits to using advanced transportation technologies, such as alternative fuel vehicles, telematics, and idle reduction technologies, to reduce transportation related emissions.

My organization/business commits to supporting the coalition by helping to promote education and outreach activities that advance sustainable transportation practices.

My organization/business commits to supporting the development of refueling, service and/or maintenance facilities for alternative fuel vehicles and advanced technologies in the central, eastern and northeastern regions of NC.

My organization/business will assist the Piedmont and Coastal NC Clean Communities coalition by providing in-kind services or financial sponsorship.

Required

I/We wish to receive additional information/assistance about the following topic (s) from the Piedmont and Coastal NC Clean Communities coalition:

Natural Gas Vehicle (s)

Propane Vehicle (s)

Electric Vehicle (s)

Infrastructure (EVSE)

Infrastructure (other alternative fuels)

Education and Outreach

Funding and Project Development

Renewable Fuels

Stakeholder Development

Other:

Would you like to join any of our committees or subcommittees? We will follow up with more details.

Advisory Committee: Provide strategic advice on the direction of the coalition.

Subcommittee on Funding Opportunities: Meet with others interested in coordinating on grant applications and other funding opportunities.

Subcommittee on Fleet Services and Support: Collaborate with others on organizing educational activities aimed at fleets.

Subcommittee on Fueling and Charging Infrastructure Planning: Collaborate with others on efforts to plan for needed infrastructure investments in the region.

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