Live Well Restaurant

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Name of Restaurant

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

To be designated as a Live Well Allegheny Restaurant, the business must first indicate its intent to work along with Allegheny County to accomplish the goals of the campaign. This can be a formal letter submitted by ownership of the restaurant or food business. In addition to referencing willingness to work with the campaign to accomplish its goals, the restaurant should also indicate what additional steps it is willing to take within its own business toward those goals. At a minimum, restaurants must commit to eliminating trans-fat oils, being smoke free, and not to sell tobacco products and commit to at least four action steps in the restaurant’s formal action for designation as a Live Well Restaurant.

I agree to the implementation of action steps related to formal designation as a Live Well Restaurant. Our restaurant will: (1/4)

I agree to the implementation of action steps related to formal designation as a Live Well Restaurant. Our restaurant will: (2/4)

I agree to the implementation of action steps related to formal designation as a Live Well Restaurant. Our restaurant will: (3/4)

I agree to the implementation of action steps related to formal designation as a Live Well Restaurant. Our restaurant will: (4/4)

Signature