Survey - Action Opportunity for Year of Air Pollution and Health Site

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Action Opportunity for Year of Air Pollution and Health Site

Contact Information:


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Zip Code: Required
	If you respond and have not already registered, you will receive periodic updates and communications from American Lung Association.

Question - Not Required - Health Credentials / Title: (MD, PhD , DO, RN, DNP, MSN, BSN, PN, LPN, LVN, MPH, CRT, RRT etc.)

Question - Not Required - Have you ever noticed poor air quality in your community? If so, how did it impact you or your family?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - What are your biggest concerns about air pollution?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Why does it matter to you that we fight for healthy air for all?

(Maximum response 255 chars, approx. 5 rows of text)