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* 1. Your name

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* 2. Location: where do you live?

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* 3. Do you agree that CRED-NB can list your name and location on our website? (At any time, you can request to have your name removed)

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* 4. Your email address  (We will send you an email to verify that you agree to list your name on our website)

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* 5. Would you like to receive a monthly CRED-NB update by email? (At any time, you can request to discontinue the email)

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* 6. (optional) if you have any comments or questions, leave them here. Thanks!

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