Survey : Questions

	Please answer the following simple questions to help us record your signature accurately on the Agenda. Your answers will also help us advance this initiative. Questions with an asterisk * are required. When you are finished click "Finish" at the bottom of the screen to submit your "signature". Any duplicate entries will be disqualified. Please ONLY ONE ENTRY PER PERSON OR ORGANIZATION.

1.	For verification purposes please enter the first 4 letters of your last name along with the four numbers corresponding with your birth month and date (IE HAGL1004)
	50 characters left.

2.

Do you wish to sign the 2012 Sustainable Tennessee Agenda Priorities? (Please visit www.SustainableTN.org to view)

Yes

No (If no skip to question 7)

3.

Are you responding on behalf of a business or organization? If so please include name of organization in the comment box below.

Yes- Organization Listed Below Only

Yes- ME AND Organization Listed Below

No

Comment:
500 characters left.

4.

May we include your Name and/or your Organization or Business Name and City on the print and online version of the 2012 Sustainable TN Agenda and website? (If yes, please include your name and city in Question 10. Note: We will only include your name and city and NOT personal information such as address, email or phone)

Yes, please include my Name and City on the Agenda

Yes, please include my Name/City AND my Organization or Business Name/City

No, I wish to sign and remain anonymous

5.

Which of the following Policy issues from the 2012 Sustainable TN Agenda are highest, second highest and third highest priority to you or your organization?

	Highest	Second	Third
Pass the TN Scenic Vistas Bill to ban Mountaintop Removal Mining practices.
Support growth of clean energy markets, energy conservation and green jobs.
No new nuclear power plants and no nuclear waste to TN landfills.
Pass a resolution requiring TVA to have a renewable portfolio standard.
Restructure Air Control Board to improve representation of health and quality of life concerns.

6.

Which of the following Practice issues from the 2012 Sustainable TN Agenda are the highest, second highest, and third highest priority to you or your organization.

	Highest	Second	Third
Conduct home energy audit then join the TN Climate Protection Campaign.
Recycling, composting and waste reduction.
Improve/increase food security/local & sustainable production.
Support and use state and local parks & greenways; and develop and increase awareness of blueways
Join, support and promote the TVA Green Power Switch program for home, school and business.

7.	As neeeded, please "write in" any priority issue not listed above. Note that ALL issues in the 2012 Agenda Priorities are important and will be worked on by various member groups.
	350 characters left.

8.	If you do NOT support the Agenda Priorities, please let us know the issue(s) you do not support and/or list any issues you believe should be added.
	350 characters left.

9.

How are you planning to get involved to support the 2012 Sustainable Tennessee Agenda? (Check all that apply)

Please include me on the Sustainable TN email list (I have included my email address in question 10)

I am willing to meet with my state legislator(s) to present the 2012 Sustainable TN Agenda

I would like to attend Conservation Education Day in early 2012

I am willing to send action alerts and other emails to my organization/friend list/listserve

I would like to volunteer for upcoming events

I will join TN Environmental Council or donate at www.tectn.org/donate.-
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I have taken one of the recommended actions found at www.sustainabletn.org

I am not able to help OR I am able to help in the following way:

Comment:
500 characters left.

10.

Please share the following demographic information with us. This will help us with implementation, including determining legislative districts. You will not be added to our email list unless you have checked the box in the previous question.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Company Name:
Home Phone:
Email Address:	emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province (US/Canada):
Postal Code:
Country: