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Thank you so much for taking the time to participate in our Climate Solutions for Restaurant Survival campaign. The questions below will help us facilitate connections with your lawmakers and create campaign resources that most accurately reflect your experience, for maximum impact

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Mobile Phone Number

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* 5. Ethnicity

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* 6. What is your tribal affiliation if you identify as Indigenous, American Indian or Alaskan Native?

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* 7. Home Address

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* 8. Home City

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* 9. Home State

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* 10. Home Zip Code

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* 11. What are your social media handles?

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* 12. What is the name of your business?

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* 13. Business State

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* 14. Are you a James Beard Program's Alum?

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* 15. If you answered yes, please specify which programs you have participated in.

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* 16. What ingredient costs in your operation have increased specifically because of climate change (e.g. your farmers’ production has been affected by extreme weather events), and by how much? If possible, please provide specific details on costs before/after increase, and/or percentage of increase.

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* 17. What ingredients do you no longer have access to because of climate change , either because it is no longer available or because it has become too expensive?

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* 18. How many days were you closed, had fewer customers, or otherwise had your operations affected because of extreme weather (extreme heat, unusual snow or freezes, etc.) in the last year?

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* 19. Have you had to lay off staff because of pressures on business tied to climate change? If yes, how many?

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* 20. How else has climate change affected your business?

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* 21. What type of activities are you interested in participating in? Please select all that apply.

Do you want to share more about your direct experience with the impact of climate change on your business(es)? If yes, here are five more questions. Answer any or all of them. Thank you for this extra time.

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* 22. What adaptations (such as changes in menus, ingredient sourcing, weatherization efforts) have you implemented to address the challenges posed by climate change?

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* 23. Have extreme weather events ever disrupted your business operations, leading to temporary closures, customer behavior (not coming in due to heat/smoke/freeze, etc.), product losses, cleanup and repair efforts, or adjustments in staffing and capacity (E.g. POS going down)? Can you provide specific examples of how your business has been affected by such events?

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* 24. Have you experienced increased costs in utilities, liability insurance coverage, business property insurance, or other insurance expenses due to climate change? Please share specific examples of how these costs have been affected by climate-related factors.

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* 25. What proactive measures do you employ to reduce your business' carbon footprint?

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* 26. Is your state or local government providing any innovative support for restaurants to increase sustainability or to adapt to climate change? If so, can you give examples?

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