Collaborative Information Form

YES! I want further Information about joining the Massachusetts Environmental Collaborative.

Name:

Title:

Organization:

Street:

City:

State:

Zip Code:

Phone:

Fax:

E-mail Address:

Web Site:

Please Include a 2-3 line statement of purpose:

Issues of Interest:

Please let us know which of the following issues are of most interest to your organization.

Air Quality Open Space Protection Transit

Coastal Protection Pesticides Water Quality

Environmental Justice Pollution Prevention/Toxics Use Reduction Watershed Protection

Habitat/Endangered Species Recycling Wetlands

Hazardous Waste Sites/Brownfields State Capital Spending Historic Preservation

State Operating Budget Land Banks/Community Preservation Act State Parks and Forests

Land Use Planning/Smart Growth Sustainable Agriculture All of the Above

Other:

	Please check box if you do not want your information shared with other environmental organizations.
	We do not give or sell your information to any commercial businesses and only with your permission will we make the information available to other environmenal organizations.

Environmental League of Massachusetts Privacy Policy.

*Name:*
*Title:*
*Organization:*
Street:
City:
State:
Zip Code:
*Phone:*
*Fax:*
E-mail Address:
*Web Site:*
*Please Include a 2-3 line statement of purpose:*

Air Quality	Open Space Protection	Transit
Coastal Protection	Pesticides	Water Quality
Environmental Justice	Pollution Prevention/Toxics Use Reduction	Watershed Protection
Habitat/Endangered Species	Recycling	Wetlands
Hazardous Waste Sites/Brownfields	State Capital Spending	Historic Preservation
State Operating Budget	Land Banks/Community Preservation Act	State Parks and Forests
Land Use Planning/Smart Growth	Sustainable Agriculture	All of the Above
Other: