Environmental Initiative Voting Form
Vote for your preferred environmental initiatives and help guide our civic group's next steps.
Your Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you a current member of the civic group?
*
Yes
No
Which environmental initiatives would you like to vote on? (Select all that apply)
*
Community Recycling Program
River Clean-Up Project
Tree Planting Campaign
Public Awareness Workshops
Other
Please rank the following initiatives in order of priority (1 = Highest Priority, 5 = Lowest Priority)
*
Rows
Priority (1-5)
Community Recycling Program
1
2
3
4
5
River Clean-Up Project
1
2
3
4
5
Tree Planting Campaign
1
2
3
4
5
Public Awareness Workshops
1
2
3
4
5
Other
1
2
3
4
5
Please provide any comments or suggestions regarding the initiatives.
How satisfied are you with the current environmental efforts of the civic group?
*
Not Satisfied
1
2
3
4
Very Satisfied
5
1 is Not Satisfied, 5 is Very Satisfied
Would you be interested in volunteering for any of the initiatives?
Yes
No
Maybe, please contact me with more information
Preferred method of contact for follow-up (if applicable)
Please Select
Email
Phone
No follow-up needed
Submit Vote
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