1.  Please choose from the following options below:

I would like to join the Valley AIRCorps program.  I understand that by joining the Air Quality Action Day network, I am agreeing to:

• Appoint a Clean Air Coordinator;

• Receive Air Quality Action Day alerts;

• Formulate an AQAD program that fits my business;

• There is no cost to join!

Please send me a free packet of materials to help me.
I would like more information about the program.

2.  Please provide the following contact information:

*Name
Title
*Organization
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
Work Phone
FAX
*E-mail
URL

3.  Please send Air Quality Action Day alerts by:

Phone
Fax
E-mail