Community Working Group

East Kaua'i Community and Circulation Plan

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Name *

Email Address *

Phone (optional)

What community groups/organizations are you affiliated with?

Interests *

	Agriculture	Business/Tourism	Civic and Community Engagement	Culture	Education	Environment	Recreation	Transportation	Other
1st choice *	1st choice - Agriculture	1st choice - Business/Tourism	1st choice - Civic and Community Engagement	1st choice - Culture	1st choice - Education	1st choice - Environment	1st choice - Recreation	1st choice - Transportation	1st choice - Other
2nd choice *	2nd choice - Agriculture	2nd choice - Business/Tourism	2nd choice - Civic and Community Engagement	2nd choice - Culture	2nd choice - Education	2nd choice - Environment	2nd choice - Recreation	2nd choice - Transportation	2nd choice - Other
3rd choice *	3rd choice - Agriculture	3rd choice - Business/Tourism	3rd choice - Civic and Community Engagement	3rd choice - Culture	3rd choice - Education	3rd choice - Environment	3rd choice - Recreation	3rd choice - Transportation	3rd choice - Other

If you selected "other" as an interest(s), please specify below:

Please describe why you are interested in volunteering for the EKCCP Community Working Group *

Please specify your t-shirt size below:

Have you read the roles and responsibilities above and do you agree to commit 10 hours per month to participating in the process?

Yes

Would you be interested in nominating a proxy to attend meetings in your stead?

Yes

Please share the name and contact information of a person you want to attend meetings for you if you cannot make it *

Has your proxy read and agreed to the roles and responsibilities of the EKCCP Community Working Group? *

Yes

Leave this field blank