Join Our Grassroots Network
Everyone deserves clean air!  
Now, you can join our grassroots network of people who want clean air! Please fill out the contact information below to add your name to the list of people who are committed to helping us Take Back Our Air in Central Iowa! You decide your level of involvement, we appreciate any help we can get! Thank you for your support!

 

Basic Information:
Please fill out all fields...

Name:
Email Address:
Mailing Address:
City:
State / Zip: /
Home Phone:
Work Phone:
Cell Phone:

Best Way to Contact You:
Agency / Organizational Affiliations:

Level of Involvement:
Please indicate your interests...
Coalition Membership
Contribute financially
Receive e-mail / updates
Attend meetings
Attend special events
Help organize special events
Call elected officials
E-mail elected officials
Write elected officials
Speak with elected officials in person
Write letters to the editor (newspapers)
Make presentations in the community
Phone calling (mobilizing / gathering data)
Investigate local tobacco-related policies
Speak at City Council meetings
Distribute petitions / door-to-door       canvassing
Media spokesperson
Speak with restaurant owners / managers
Help distribute materials to local outlets

Additional Comments: