JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Join Cultivating Connections!
Make the Pledge to Cultivate Connections! Join Madison County Conservation on our journey to mend connections in nature and to each other.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First & Last Name:
*
Your answer
Email:
*
Your answer
Select your age range
*
Choose
Elementary School
Middle School/Junior High
High School
18-25
26-35
36-45
46-55
56-65
66-75
76-85
86+
Do you live in Madison County?
*
Yes
No
If YES, select which Madison County town do you live in:
Winterset
Earlham
St. Charles
Truro
Patterson
East Peru
Macksburg
Bevington
Other/Rural
Clear selection
If NO, please list the city/county and state you live in:
Your answer
What's your WHY? What motivates you to help mend connections in Nature?
*
Your answer
Make the pledge! What actions can you take in your own life to help mend connections in Nature?
*
Plant native plants
Plant an Oak tree
Volunteer and engage with Madison County Conservation
Leave the leaves
Turn off outdoor lights
Remove invasice species
No till/cover crop agriculture
Explore nature with others
Grow & share food
Support local efforts and businesses
Tell others about Cultivating Connections
Engage with Cultivating Connections partners
Other:
Required
What help or resouces do you need to take action?
*
Your answer
Please provide any feedback you have about the Cultivating Connections program.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Drake University.
Report Abuse
Forms
