Rethink Your Drink Materials Use Tracking Form

1. Introduction

Thank you for being a champion for change with Rethink Your Drink! By returning this form, you'll help to ensure that this Nutrition Education Initiative continues to receive funding to improve the health of California.

Question Title

* 1. Please provide the following information about yourself:

Name/Title:

Organization Name:

Address:

City/Zip:

Phone:

Question Title

* 2. What counties do you serve (mark all that apply)?

Alpine

Amador

Calaveras

El Dorado

Mono

Placer

Tuolumne

Sacramento

San Joaquin

Solano

Stanislaus

Sutter

Yuba

Yolo