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2. First Name*
3. Last Name*
5. Email*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone Number*
17. How many people are in your household?
19. Adults*
20. Children (15 and under)*
22. Why are you interested in using this organics diversion and composting (check all that apply)*

    1. Better than putting these resources in the landfill
    2. Good for soil
    3. Good for the environment
    4. Think it's the right thing
    5. Someone in my household really wants to
    6. Other (please specify below)
24. Specify Other reason, if applicable
26. How did you hear about this opportunity?*

    1. Facebook
    2. Instagram
    3. Whitehall E-Update
    4. From a friend, colleague, family member
    5. Found opportunity on website
27. Have you composted before?*
    -- Select One --YesNo
29. The first 200 households to register are eligible to receive a free two-gallon buckts for you to store and transport organic scraps to the food waste drop-off location. You must pick up the bucket at 360 South Yearling Road (Whitehall Municipal Building). Would you like a bucket?*
    -- Select One --YesNo
31. Have questions? We'd love to answer them! Give us a call at 614-237-8612 or email Kelsey at kelsey.miller@whitehall-oh.us
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

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