Name *

First Name

Last Name

For the month of March, I pledge to reduce and eliminate my use of single-use plastic straws. By refusing single-use plastic straws, I am helping to eliminate plastic pollution that ends up in our oceans and waterways. Please check the "Yes" box if you agree.​​​​​​​ *

Yes

Address *

Address 1

Address 2

City

State/Province

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Country

The owner or manager of the business indicated above agrees to this pledge. *

Yes

We are officially participating in the #SkiptheStraw March movement as part of an effort to keep my community pollution free and stop plastic pollution at the source *

Yes

As a participating business we agree to: *

Check all that apply

Print "Straws Available Upon Request" on our menu or signage

Discontinue the use and purchase of plastic straws and elect to use fully compostable paper straws or reusable straws (not bioplastics, which are not degradable or recyclable)

Last Day of Straw Usage

MM

DD

YYYY

Electronic Signature *

By typing your name in the box below you indicate that all of the information you have provided in this form is true to the extent of your knowledge and binds you to any agreements that you have indicated in this form.

First Name

Last Name