Membership Application Form for Businesses

Business Name *

Business Location *If the company has multiple locations, please put the one where you/the contact person report to.

Business Website *

Name of Contact Person * We may contact this person as part of your company's membership application process.

Contact Person’s Role in the Company *

Contact Person’s Email *

What is the nature of your business? *If you select "other", please describe in few sentences what you company does.

Manufacturer

Service Provider

Retailer

Other

Do you produce single-use plastic items? *

Yes

Do you use single-use plastic to package your products? *

Yes

Do you sell or give away single-use plastics? *

Yes

Do you sell or make plastic-free, reusable, and/or zero waste products as the bulk of your business? *

Yes

Does your business implement reuse or refill systems or practices? *

Yes

Does your company agree with the vision that the production of plastic must be reduced as far as possible? *

Yes

How does your business manage the plastic packaging used for your products? *You can choose more than one.

We don’t; we leave waste management to local governments

We don’t yet, but are currently researching/making plans for managing the plastic waste we produce

We collect and recycle them

We hold cleanup drives

We contribute towards some or all of the financial cost of collection and recycling

We will reduce the amount of plastic we consume/produce

This question isn’t applicable to us

Other

Does your company support waste incineration and/or any of its variants like thermal waste to energy, gasification, etc.? *

Yes

Does your company endorse ‘novel recycling technologies’ such as chemical recycling, plastic to fuel or pyrolysis? *

Yes

Does your company endorse bioplastics or plastic made from plants or unusual feedstocks as substitute for fossil fuel based plastics? *

Yes

Does part of your profit go to support of waste prevention activities? If so, which ones? *Please put N/A if No.

Does your company receive funding from the plastics and/or fossil fuel industry? *

Yes

What are your principal motivations for joining the Break Free From Plastic movement?

If you have an additional information for BFFP please enter it here?

Disclaimer *

I understand that submitting this form doesn't guarantee my company's membership in the movement and that I may be contacted by a Break Free From Plastic representative for more information.