I Heart Tap Water Pledge Form

Questions marked with an asterisk (*) are mandatory.

I pledge to: 1] Make tap water your beverage of choice. 2] Use a refillable water bottle.

1	* Please complete the following information: Last Name: First Name: UC Berkeley Email Address:

2	Are you: UC Berkeley Student UC Berkeley Staff UC Berkeley Faculty

3	* Check all that apply: I currently use a refillable water bottle. I don't refill my water bottle on campus. I would like to refill on campus, but don't know where

4	IF YOU CURRENTLY REFILL ON CAMPUS, where is your favorite tap water refill spot: