* 1. Do you have access to convenient disposal options for unwanted medications (meds) and used needles (sharps)?

* 2. Where would you like to have access to a collection (disposal) program for unwanted meds and used sharps?

* 3. Do you think meds and sharps manufacturers should share in the responsibility of providing convenient disposal options?

* 4. Do you pledge to properly dispose of meds and sharps?

* 5. Please tell us your story about what you have done to properly dispose of meds or sharps. Did you find it challenging or easy?

* 6. Please provide us your residential zip code.

* 7. Optional: Please provide your contact information including name and email.

* 8. Optional: How did you find out about this pledge?