Exit touch down survey Question Title * 1. I pledge to immediately refrain from any use of any substances or drinks that alter or impair my mental or physical state while operating any form of transportation. I am committed to ending the negative repercussions of Impaired Driving by being a focused, responsible driver. I hereby pledge this life-long commitment. (sign name below) Question Title * 2. School/Organization Question Title * 3. Grade (if applicable) Question Title * 4. Email Address Question Title * 5. Gender Male Female Non-Gender Specify Question Title * 6. Age 12 and under 13 - 17 years old 18 - 30 years old 31 -50 years old 51 - 65 years old 66 and older Question Title * 7. I would like to be added to the CARES Club email list Yes No Done