Plastic-Free Campaign Discharge Form
Please fill out this form to acknowledge your participation and discharge in the Plastic-Free Campaign.
Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Campaign Participation
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I hereby acknowledge that I have participated in the Plastic-Free Campaign and release all related liabilities.
Signature
Submit
Should be Empty: