Welcome to the
Business, Community, Organization, Publication, Website (BCOPW) Survey Form

Please provide us with the following information. Then click the "Submit" button. Thank you for filling out the form as completely as possible. If you have questions call us at
717/284-6318 or JWIrwin@Permaculture.net

Instructions for this form:

  • Please do not fill out multiple forms for the same business & activity.
  • Just fill in the descriptions that apply.
  • Publications please include deadlines.
Today's Date
New Form Update Form
BCOPW Name
Identifying Description: (Personal?Family?Partnership Business)(Non-profit/Bioregional Org)(Monthly/quarterly Pub) etc...
Business Community Organization Publication Web Site
Internships available? Yes If yes, please fill out the internship information form.
501c3
Original Startup Date
Cost of Membership/Subsciption
First Name
Email
Last Name
Web Address
Title
Address & Apt #
PO Box, Rural Route, etc
City
State
Zip/Postal Code
Country
Home Phone
Work Phone
Fax
Other contact people
Description in 50 words or less:

 

 
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