Safe Streets Community Safety Helpline
Thank you for your interest in improving the safety of people on foot and on bike in your community. You can use this form to ask questions or order resources. We're here to help YOU.
First Name *
Last Name *
e-mail *
phone *
Town *
This is the community for which you are requesting the information or safety resources.
Target audience *
Are you looking for information for a specific group? (You can choose more than one group)
Required
Do you have an issue or question that you would like assistance with?
If so, then put your question in the box below.
What resources are you interested in? *
This is for ordering our "paper' resources only. For a more extensive list, including resources available to download, go here: http://bit.ly/Safe_Street_Resources Don't need any? Click "Don't need any resources."
Required
Requested quantity of resources *
Please indicate your ideal quantity for each resource, as well as the minimum that you require in order to feel confident that you will have enough. Ex: "Ideally 200 Bike Law Sheets, but absolutely need 90" Don't need any? Write "none"
Address for Mailing Paper Resources *
Some of our materials are digital (the curricula, for example), but we often do have paper resources that we are happy to mail to you. If you would like them mailed to you, write your address below. If you do not want paper materials mailed to you, write "none" Thank you!
Submit
Never submit passwords through Google Forms.
This form was created inside of Local Motion. Report Abuse