2. 
4. Are you a Super Water Saver?

   Share your water-saving success story!

6. First Name*
7. Last Name*
9. Phone Number*
10. Email Address

    * We will only use your email address to contact you about the Super Saver campaign.

14. Please describe your Super Water Saving actions, including when you started this behavior or implemented this action. *
16. Upload photo

    Share a photo(s) of your Super Saver action or behavior.

18. Upload photo
20. I hereby grant permission to the City of Santa Rosa to use my likeness and/or that of my child/children and/or family, whether through the use of photographs, film, videotape, or other media, for City promotional and public outreach purposes. I understand that my likeness may be used in City publications, literature, the internet, or other visual means that the City may choose to use to promote the City, its various departments, and its activities. *

    1. Yes
    2. No
22. I would like to be added to a list of possible people to be interviewed by the press to talk about my Super Water Saver habit or action*

    1. Yes
    2. No
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field