Local Climate Solutions Listening Campaign - Potluck Interest Form

First name:

Last name:

Primary email:

Street address:

City:

State:

County of residence:

Home zip code:

Are you a member of the health community?

I am interested in the following:

1) Host (lead a gathering in July or early August — with support, at a local park, your backyard or in your home)

2) Co-host with someone else (collaborate closely with a host)

3) Participate- I can show up and participate but can’t commit to helping organize

4) Not sure yet but I’d like to learn more…