Endorser Registration Form

Organization Name:

Principal Contact:

Title:

Address:

City:

State: Zip:

Phone Number:

Fax Number:

E-mail Address:

Approximate number of business members in your organization:

SIC Code:

SIC Code:

SIC Code:

SIC Code:

As a WasteWise Endorser, my organization commits to conduct activities in each of the following two areas:

1. Within the next six months, initiate a campaign to recruit my organization's member companies to become WasteWise partners. (Please briefly describe your planned activities.)

2. After completing the membership drive, provide my organization's members with ongoing promotion of the WasteWise program and/or information on waste reduction strategies. (If known, please briefly describe your planned activities. If not yet known, you may notify EPA of your plans at a later date.)