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FACTS PLEDGE MAP
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I pledge to LEAVE THE PHONE ALONE while driving. From now on, I will avoid distractions caused by talking, texting or using a hand-held electronic device while behind the wheel of my vehicle. ”

Why are we asking this?

This information is only collected for statistical purposes and to help map the campaign’s progress.

The information collected will be displayed on the map like this: John S., 32, Toronto, ON / Mary B., 19, Vancouver, BC.

Your e-mail address will only be used to send you a confirmation message with your personalized link to the map.

Your mailing address will only be used to send you a sticker, if you want one. Your information will never be disclosed to third parties or used for other purposes.

By filling out the form, you are providing your consent to CCMTA to collect, use and disclose the personal information contained therein for the purposes outlined above.


First Name

Last Name



E-mail Address

Age

Gender



How did you hear about us?

Please Specify



City (In Canada Only)

Street Address

Postal Code
OPTIONAL — Get your FREE car window sticker by mail:


Yes Please!
No Thanks.
sticker
Mailing Address
All fields are required.


At the moment, only Canadian pledgers may participate in this initiative.

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