Organizational Endorsement of the Louisville Charter

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This form is for ORGANIZATIONS that want to add their organization's name as a public endorser of The Louisville Charter for Safer Chemicals.

If you want to add your name as an Individual endorser of the Louisville Charter, please use this form instead: https://forms.gle/RakUy39TqneFubNZ7

All organizational endorsements will be publicly listed on Coming Clean's web site, and used publicly in other ways. Please fill in the information on the form EXACTLY as you want it to appear on public pages and documents.

The information in the first two questions below (organization name and location) will be listed publicly.

Organization Name (exactly as you want it to appear publicly) *

Location of the Organization (or it's primary location or headquarters) as you would like it listed publicly. Please include CITY and STATE. *

The remaining questions (below this point) are for internal use only. These responses will NOT be shared publicly.

Scope of the Organization's Work (choose one) *

Local

Statewide

Regional

National

International

Contact Person Name *

Email Address for Contact Person *

Phone Number for Contact Person

Web Site for the Organization

Please check boxes below if you would like to:

Receive more information about the Coming Clean network and membership

Learn more about how to use and promote the Louisville Charter

Other:

Is there anything else you'd like us to know?

Confirmation of Authority to Endorse on Behalf of the Organization *

I certify that I have the authority or approval required to add this organization's name as an endorser of the Louisville Charter for Safer Chemicals, and that I understand that the organization's endorsement will be listed publicly.

Required

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