Sign the Lake Source Cooling Coalition Letter

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Last Name

Honorific

If you have an honorific such as "PhD", "Esq.", "RN", "MD", etc., we encourage you to include them here. It will appear after your name. If you have multiple honorifics, list them with commas such as "PhD, MD".

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Providing your address here will not subscribe you to a mailing list. We use e-mail addresses to help sort out duplications. You will have an opportunity to subscribe to our mailing list on the following page after submitting this form.

Address

We ask for your address in order to show that we are collecting legitimate signatures. **YOUR ADDRESS WILL BE PUBLISHED ON THIS WEB SITE** If you have any concerns about providing this information, please contact us: info@toxicstargeting.com.

City

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Title

If you have a title such as "Executive Director", "Assemblywoman", "President", etc., please enter that here.

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Sign the Lake Source Cooling Coalition Letter

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