This study examines the activities of governments and researchers in six cities and urban regions to integrate climate concerns into policy and programs, and to adapt to climate change. The cities/urban regions studied were: London, New York City and the Metro East Coast Region, Boston Metropolitan Region, Halifax Regional Municipality, Nova Scotia, Canada, Greater Vancouver Regional District, British Columbia, Canada, Seattle and King County, Washington, USA. The report provides lessons from the experience of these early adapters, and outlines a way in which municipalities can set in motion their own process of adaptation. It also provides many examples of municipal adaptation policies and specific adaptation measures and actions.