Southeast Missouri Climate Protection Initiative (SEMOCPI)
 Local Businesses Go Green Questionnaire

Please be aware that some networks appear to be set up to prevent submission of forms such as this.  If you do not see a confirmation page identifying your answers when you click 'submit' below, the page probably was not sent. If this happens, please print a hard copy of the form, complete, and submit by regular mail to Jill Wicks, 2812 Oakshire Circle, Cape Girardeau, MO 63701-2014

Who Are You?

BUSINESS / ORGANIZATION NAME:                       

BUSINESS /ORGANIZATION ADDRESS:                      
                                                                      

NATURE OF BUSINESS / ORGANIZATION (i.e. what do you provide?):
                                                                       

NAME OF CONTACT PERSON:                              

EMAIL ADDRESS OF CONTACT  PERSON:               

TELEPHONE NUMBER OF CONTACT PERSON:                    

Our interest is in recognizing all groups (from businesses to non-profit community service groups, to public entities such as schools and government agencies) in Southeast Missouri who are taking steps to reduce energy consumption (and thus their carbon footprint) and adopt more environmentally sensitive approaches to what they do.

SOME EXAMPLES OF ACTIVITIES THAT HAVE BEEN LISTED:

a)    Recycle various material (identified)
b)    Encourage employees to reduce energy use
c)    Promote car-pooling
d)    Installed energy efficient (CFL or LED) light bulbs
e)    Use or sell locally produced items

9) Please Identify what you are doing to reduce energy consumption, your carbon footprint and your general environmental impact (please
include but do not limit yourself to the items listed above):                                                                         


WOULD YOU LIKE SOMEONE TO CONTACT YOU TO DISCUSS THIS FORM?

Please provide us a link to an icon or logo that we can use for you on our web page:
                                                             

If you do not have a web site with a logo, please send us an electronic image (jpg or similar format) that we can use.

Thank you for your interest in the SEMOCPI 'Local Businesses Go Green' Program.

IF YOU HAVE ANY ADDITIONAL COMMENTS ON THIS FORM OR PROJECT, PLEASE ADD THEM BELOW:



If you have problems with this online form, please contact us  and identify the problem.