Pick 5 for Clean Air Lawton Survey

1. What is your name (First and Last)?

What is your name (First and Last)?

2. What is your address?

What is your address? Address:
Address 2:
City/Town:
State:
ZIP:

3. What will you do for cleaner air?

What will you do for cleaner air? Shut down electronics (TVs, computers, stereos) every night.

Bicycle to work at least once a week.

Plant at least one tree in your yard.

Keep your car properly maintained.

Buy local: Make as many purchases as possible in Lawton, instead of driving out of town.

Tell a friend to join the Pick 5 program.

No lawn mowing before 6:00 PM or at all on Air Action Days.

Car or vanpool to work at least once a week.

Don't use drive-thrus. Walk in instead.

Turn off the AC in your car when you drive to work in the morning.

Minimize vehicle trips on Air Action Days.

Bring your lunch or walk to a nearby restaurant at least once a week.

Purchase fuel after 6:00 PM.

Take the LATS bus to work at least once a week.

Wash clothes using cold water.

Trip Chain (run all of your errands back to back so your engine stays warm) on weekends.

Replace at least three incandescent light bulbs with CFC or LED light bulbs.

4. Please enter your email address and/or telephone number so that we may contact you in case you win a prize.

Please enter your email address and/or telephone number so that we may contact you in case you win a prize. Email Address
Telephone Number

5. Thank you for joining the Clean Air Lawton Pick 5 program. By submitting this survey you not only help Lawton's air, but you are also being entered into a random prize drawing! We encourage everyone to sign up for the program, however only those 18 and older are eligible for the drawing.

Thank you for joining the Clean Air Lawton Pick 5 program. By submitting this survey you not only help Lawton's air, but you are also being entered into a random prize drawing! We encourage everyone to sign up for the program, however only those 18 and older are eligible for the drawing. I am at least 18 years old.

I am less than 18 years old.

6. Are any of your immediate family members (including yourself) or anyone living within your household City of Lawton employees?

Are any of your immediate family members (including yourself) or anyone living within your household City of Lawton employees? Yes

No

Pick 5 Random Drawing Program Rules

• All participants are entered into the weekly random drawing.
• All participants stay in the drawing pool each week unless they win.
• Winners are ineligible for future weekly drawings.
• If no contact information is provided by the winner of a drawing and that winner cannot be contacted, another winner will be chosen.
• If contact cannot be made with a drawing winner within seven days of the drawing, another winner will be chosen.
• All prizes must be claimed within 30 days of winning ticket drawing.
• Prizes may not be returned for a refund from the prize donor or exchanged for other items at the prize donor’s establishment.
• All participants must be at least eighteen years of age to enter the random prize drawing.
• Each participant may sign up for the Pick 5 Random drawing program one time only.
• City employees and elected officials, and members of their households are encouraged to join the Pick 5 Program, but are ineligible for the random prize drawings.

Thank you for being a part of Clean Air Lawton, and thank you for helping us make a positive difference!

Pick 5 for Clean Air Lawton
Exit this survey

1. Check at least five of the following items:

1. What is your name (First and Last)?

2. What is your address?

3. What will you do for cleaner air?

4. Please enter your email address and/or telephone number so that we may contact you in case you win a prize.

5. Thank you for joining the Clean Air Lawton Pick 5 program. By submitting this survey you not only help Lawton's air, but you are also being entered into a random prize drawing! We encourage everyone to sign up for the program, however only those 18 and older are eligible for the drawing.

6. Are any of your immediate family members (including yourself) or anyone living within your household City of Lawton employees?

Pick 5 for Clean Air LawtonExit this survey

1. Check at least five of the following items:

1. What is your name (First and Last)?

2. What is your address?

3. What will you do for cleaner air?

4. Please enter your email address and/or telephone number so that we may contact you in case you win a prize.

5. Thank you for joining the Clean Air Lawton Pick 5 program. By submitting this survey you not only help Lawton's air, but you are also being entered into a random prize drawing! We encourage everyone to sign up for the program, however only those 18 and older are eligible for the drawing.

6. Are any of your immediate family members (including yourself) or anyone living within your household City of Lawton employees?

Pick 5 for Clean Air Lawton
Exit this survey