District of Fort St. James - FoodCycler Pilot Program Registration Form

The FoodCycler Program for the District is now full and you will placed on a waitlist. Thank You.
1.What is your first and last name?(Required.)
2.What is your email address?(Required.)
3.What is your phone number?(Required.)
4.What is your civic address?(Required.)
5.What is your postal code?(Required.)
6.Please select which FoodCycler model you would like to purchase for your household:(Required.)
7.I acknowledge that by participating in this pilot program and obtaining a municipally subsidized FoodCycler, I am required to track usage for 12 weeks and complete a brief exit survey about my experience with the program.(Required.)