The Black and Gold City Goes Green: Survey - Registration for the Black and Gold Water Savers Competition

Registration for the Black and Gold Water Savers Competition

Registration for the Black and Gold Water Savers Competition

Congratulations on taking this step to help our region go green. Your organization's participation in the Black and Gold City Goes Green campaign will help our region become even cooler.

PRIMARY CONTACT:

Please designate one person to be the primary contact for your organization regarding this competition.

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Name:

First Required	Last Required

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Email: Required

Yes, I would like to receive e-mail from Citizens for Pennsylvania's Future (PennFuture)

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Question - Required - Your title:

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Question - Required - Office phone:

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Question - Required - Office address:

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Question - Required - City:

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Question - Required - State:

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Question - Required - Zip code:

ADDITIONAL LIAISONS:

Question - Not Required - If you would like to designate multiple competition liaisons, then please provide the following information for each person - Name, Title, Phone and Email.

ORGANIZATION INFORMATION:
Please provide the following information about your organization.

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Question - Required - Organization name:

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Question - Required - Number of people:

DEPARTMENT:

Question - Not Required - If you wish to breakdown your organization into departments, please supply the department name(s) and number of people in each. You may create as many department slots as needed.

COMMENTS:

Question - Not Required - If you have any comments, questions or addition information, please provide it here.

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Question - Required - Before submitting, please type the text you see below:

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