Houston-Galveston
Clean Cities Coalition
Membership Form
Houston-Galveston Clean Cities Coalition (HGCCC) is part of national network of U.S. Department of Energy coalitions that
support petroleum reduction and improve air quality through the deployment of alternative fuels and technologies in the
transportation sector. HGCCC hosts stakeholder meetings, workshops, and training events to provide information and
assistance to fleet managers, fuel providers, and others interested in alternative fuels.
Please indicate whether you would like to participate as a Houston-Galveston Clean Cities Supporter OR Stakeholder.
Clean Cities Supporters are individuals, entities, and interested citizens who want to remain informed about events
and receive newsletters, invites, and announcements from HGCCC.
____ I want to become a Houston-Galveston Clean Cities Supporter. Please add me to the HGCCC mailing list.
Name:
Organization:
Email:
Clean Cities Stakeholders are individuals or entities, based/residing in the greater Houston area, that pursue and/or
promote alternative fuels and clean vehicle technology projects and opportunities. Individuals and entities are asked to fulfill
requirements outlined below.
____ I want to become a Houston-Galveston Clean Cities Stakeholder.
____ I have attached a formal statement of support for the HGCCC.
____ I will email [email protected] with a statement of support for the HGCCC.
Stakeholder Benefits
Organization logo on our website with link to webpage
Member spotlight in a Coalition quarterly newsletter
Public recognition for long-term commitments
Networking opportunities at Coalition meetings,
workshops, and events
Stakeholder Commitments
Affirmation of Coalition goals on organizational letterhead
Complete annual survey
Provide input to the Coalition Annual Operating Plan
Provide input on either the Marketing Team or the Education
Team
Stakeholder Contact Information
Name:
Organization:
Address:
City, State, Zip:
Primary Representative 1:
Title:
Email:
Office Phone:
Cell Phone:
Representative 2:
Title:
Email:
Office Phone:
Cell Phone:
Please include names and emails of other individuals who may wish to receive emails and invitations.
____ I allow my contact information to be included in the Member Directory and made available to all stakeholders.
Stakeholder Interest Information
Select the category that most closely describes your Select the alternative fuel and technologies of interest
job
(check all the apply)
____ Public Sector Policy and Planning
____ Biodiesel
____ Fuel Provider/Utility
____ Electric / plug in hybrid
Type of fuel(s): _________________________ ____ Ethanol
____ Equipment/Service Provider
____ CNG/LNG
Industry/sector: ________________________
____ Propane
____Fleet Manager
____ Vehicle Efficiency
____Government Entity
____ Idle Reduction
____Non-Profit
____ VMT Reduction
____Other Organization:_________________________ ____ Other technologies: ________________________
Why would you like to become a Houston-Galveston Clean Cities stakeholder or supporter?
Does your company/entity provide products or services that are related to HGCCC? If so, please describe.
Does your company/entity operate vehicle fleets and/or fueling infrastructure in the greater Houston region? If so, please
describe.
Please describe any ways your organization may be able to aid HGCCC in accomplishing its goals of emission reductions
and petroleum displacement.
For more information, visit www.mysolutionis.com/fleet-management/clean-cities-coalition
Please return this form:
via mail
Houston-Galveston Area Council
Attn: Clean Cities
P.O. Box 22777
Houston, TX 77227-2777
via email
[email protected]