Businesses Endorse Fracking Ban

Constituency-form-final-1.pdf (application/pdf Object).

 

Endorsement
Form
I
support
a
ban
on
fracking
in
New
York.
I
urge
Governor
Andrew
Cuomo
and
the
New
York
State
Legislature
to
prohibit
this
dangerous
method
of
gas
drilling
that
threatens
our
water,
food,
and
air,
and
would
endanger
our
communities,
economy,
and
environment.
Your
Name:
_______________________________________________________________________________________________________________
Address:__________________________________________________________________________________________________________________
____________________________________________________________________________________________Zip
Code:
_____________________
Phone
Number:_________________________________
Email
Address:_______________________________________________________
Please
tell
us,
in
2
or
3
sentences,
why
you
support
a
ban
on
fracking:
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Name
of
company,
institution
or
organization
_______________________________________________________
Web
site:
_____________________________________________
Your
title:
____________________________________________
Type
of
organization
(please
circle
all
that
apply):
Business:
Farm
Restaurant
Food
&
beverage
industry
Real
estate
Tourism
Health
care
or
public
health
Other:
_________________________________
Non-­‐Profit
Organization:
Environmental
Business
association
Union
or
labor
Student
Faith-­‐based
Other:______________________________________
Please
check
here
if
you
are
signing
on
behalf
of
your
business
or
organization:
_______
Please
check
here
if
you
would
like
your
affiliation
listed
for
identification
purposes
only:
_________
By
signing
this
form,
you
agree
to
allow
New
Yorkers
Against
Fracking
to
list
you
and/or
your
organization,
institution,
or
company
on
our
web
site,
be
included
in
media
announcements,
and
be
added
to
public
education
materials.
For
more
information,
or
if
you
have
any
questions,
please
contact:
David
Braun:
david@nyagainstfracking.org;
917-­‐514-­‐0700
Endorsement
forms
can
be
returned
to:
c/o
Food
&
Water
Watch,
155
Water
Street,
6th
Floor,
Brooklyn,
NY
11201
http://www.NYAgainstFracking.