| Becoming part of Clean Air NY takes just a few simple steps. |
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Would you like to register as an individual or an employer? |
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Fill out the rest of this form. Items with an * are required.
The other items are optional, but we encourage you to provide that info
so we can continue to tailor Clean Air NY to meet your needs. |
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| * Employer Name |
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* Name
* Contact Name
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| Address |
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| City |
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| State |
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| * Zip Code |
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| County |
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| Phone |
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* E-Mail OR
Fax |
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| Contact Cell Phone |
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| Alternate Contact Name |
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| Alternate Contact E-Mail |
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| Employer Web site Address |
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| # of Employees |
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| Employer Logo |
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| Employer Type |
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| How Did You Hear About Us? |
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| When you become part of Clean Air NY, you will receive the
following items. If you would prefer not to receive Clean Air Connections
or The Latest Breeze, uncheck those boxes. |
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| Air Quality Action Day Bulletins |
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| Clean Air Connections—Our quarterly e-newsletter |
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| The
Latest Breeze—Our periodic e-mails full of tips and advice on
how to improve air quality, reduce driving and save time and money |
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