We’d like to hear about your top air quality concerns. Thanks for taking the time to fill this out!

This survey will take approximately 5 minutes to complete.
For general information, please visit: www.OurAir.org

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* 1. I am:

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* 2. My zip code or nearest major street/intersection:

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* 3. My concerns about air pollution: (Please choose up to 3)

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* 4. What sources of air pollution would you like us to target for grant funding? (Please choose up to 3)

For more information on clean air grants, see: www.OurAir.org/clean-air-funding-programs

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* 5. Do you feel you are prepared for poor air quality in the event of a wildfire?

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* 6. Do you have an air purifier at home?

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* 7. Do you have a "clean air room" ready in case of a fire?

For more information on clean air rooms, please visit: https://www.OurAir.org/clean-air-rooms

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* 8. OPTIONAL- Please contact me to discuss:

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* 9. OPTIONAL- Add me to your email list for:

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* 10. Please provide us with your contact information if you responded to the two preceding questions:

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* 11. My preferred contact method is:

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