Date Completed

I reside in the following county: Choose one Bibb Fayette Greene Hale Lamar Pickens Sumter Tuscaloosa

My age is: Choose one Less than 18 years 18-25 26-40 41-64 65+

I live in the following area: Choose one Rural Incorporated City or Town

I am a: Choose one Elected Official Community Organizational Leader Community Volunteer Private Citizen Business Owner/Operator Other If other:

I am: Choose one Male Female

I am interested in becoming a volunteer with Tombigbee RC&D:

Contact me (email address) (optional)

Contact me (Phone) (name)

I believe the greatest problem or need of my community/county/region is:

The Tombigbee RC&D Council should spend the following amount of time and energy on the following types of projects:

Environmental/Agricultural Education Choose one More About the Same Less

General Education Choose one More About the Same Less

Small Farmer/Alternative Agriculture Choose one More About the Same Less

Community and Economic Development Choose one More About the Same Less

Tourism Promotion for Economic Development Choose one More About the Same Less

Recreational Facilities Choose one More About the Same Less

I believe the Tombigbee RC&D Council should look into these projects in the USDA/NRCS categories:

Land Conservation

Water Management

Community Development

Land Management

Please use the following space to record any comment, concern, or suggestion for the Tombigbee RC&D Council to consider in its future plans: