Community Emergency Response Form

Name

Telephone Number

Name of Community Impacted by the Emergency Event

Describe Emergency Event

Are you a part of a community group?

If you're not part of a community group, would you like ECO-Action to help you form a community group to address this concern?

Provide organizing and technical assistance so that Georgia low-income communities and communities of color can empower themselves to eliminate air, land, and water pollution.

Community Emergency Response Form

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