Submit Your Respect My Ride Entry

Required information is in red!


First Name
Last Name
E-mail
Confirm E-mail
Address
City
Zip Code
School /College
Category
Entry URL	The Web site address that links to your entry.
Comments	Tell us 1) why it’s important to have a smoke-free car and 2) what motivated you to develop this project:

Pledge	I pledge to keep my car smoke-free.
Resident/Student	I am a resident of, or attend a high school or college in, Dakota County.
Rules	I have read and abide by the contest rules.
Consent	I am 18 years of age or older or I have downloaded the parental consent form. [Download consent form in Word format.]

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A public service campaign of Dakota County Public Health Department.

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