Let us know what you did last month!

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Whether you were able to collect signed petitions from your friends, family, and neighbors, or you spent a few hours helping us raise funds or awareness, we want to know how you -- as an individual or on behalf of your organization -- helped to ensure the Florida Right to Clean Water citizens' initiative is a success.

We will be tracking these numbers and, at the end of this year, we'll be acknowledging your hard work with various forms of appreciation. (For students needing community service hours, this also helps us track what you need to turn in.) If you do not wish to be publicly acknowledged, please let us know, and we will only track the numbers you provide.

If you have any questions, please don't hesitate to contact us at admin@floridarighttocleanwater.org.

Email *

First and last name

Phone number if better than email

County

City

I'm reporting as:

an individual volunteer

on behalf of an organization (nonprofit / business)

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Name of organization, if appropriate:

Other individuals assisting me I'd like to recognize:

In the last month, I collected this many signed petitions:

In the last month, I volunteered this many hours to the initiative:

If you've given more to the campaign such as incurring out-of-pocket expenses, please let us know!

Note: Expenses may be reimbursable if you first seek guidance and permission from your Regional Coordinator or County Captain. Please be sure to keep receipts!

Also: All contributions (monetary or in-kind donations) must be reported to the State of Florida through campaign finance reports, so we will need your address and, if your in-kind donation is over $100, your occupation as well. Thank you for understanding!

In the last month, my in-kind donations totaled:

My address is:

If the total is over $100, my occupation is:

A copy of your responses will be emailed to the address you provided.

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