"Why I Stay Safe" Employer Pledge
Thank you for completing this form! We'll be using this information as a simple way to measure the impact of the campaign. We'll never give your contact information to any third party.
Email address *
1. Company Name *
2. Company Address (city & state)
Please include at least city & state so we know where your company is located.
3. Number of Employees (estimated) *
This is just so we can measure the potential impact of the campaign.
4. Email *
5. Contact *
6. Title
7. How do you plan on using the Why I Stay Safe Campaign? *
Check all that apply.
Required
8. Can we publicly recognize your company as an employer who took the pledge? *
We only do this to encourage other employers to take the pledge & promote Why I Stay Safe at their workplaces.
9. In your own words, why is your company taking the pledge?
10. Would you like to sign-up for the "Why I Stay Safe" email list for free campaign ideas, tools & success stories?
We won't sell your info or blow your email up with needless messages. We'll only email you occasionally when new information, campaign tools or success stories become available.
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