* 1. I support the efforts to bring a statewide charter school option to the Smyrna Area

* 2. Name

* 3. Address

* 4. Phone Number

* 5. E-Mail

* 6. Number of Children

* 7. Grade of Children (Check All that Apply)

* 8. Would you like to be actively involved in the efforts (work on a committee, host a meeting, distribute information, etc)?

* 9. If answered yes above, how would you like to be involved?

* 10. What is best way to contact you?

* 11. I would like to receive email updates at the address listed above

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