Your Name: *

First Name

Last Name

Owner of Business Name (if different):

First Name

Last Name

Contact Phone Number: *

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Alternate/Off-Season Phone Number:

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Mailing Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Physical Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Environmental action(s) you will be implementing: *

Provide plastic straws to customers only upon request

Encourage the use of reusable bags

Switch to recyclable paper options

Switch to eco-friendly cleaning products

Switch from using styrofoam to recyclable products

Start composting or join a composting program

Plant native flowering plants for pollinators

Make my landscaping pesticide and/or herbicide-free

Establish annual or regularly scheduled invasive plant species clean-up days

Take part in "No Mow May"

Mow with monarchs in mind

Partake in an all-employee volunteer day with a conservation organization

Source local farms or companies for food and drink options

Feature in-season collected invasive species menu items

Invest in renewable energy options and/or reduce electricity use (please specify in text box provided below)

Other (please specify in text box provided below)