JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
FY23 Portage County Safety Council Interest Form
Starting in July 2022 (FY23), the rebate program and monthly in-person meetings will return to all Ohio safety councils. To help us better serve you, please complete this brief FY23 interest form.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Company
*
The name of the name of the company or organization you represent.
Your answer
Name
*
Your first & last name.
Your answer
Email
*
Your answer
Phone
*
Please include the extension number if applicable. We will not share your information.
Your answer
Are you the primary safety council contact person?
Yes
No
Clear selection
Will your company be participating in the Portage County Safety Council for the FY23 rebate program?
*
FY23 runs from July 1, 2022 - June 30, 2023.
Yes
No
Unsure
Are you interested in serving on the Portage County Safety Council Steering Committee?
Yes
No
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
