Pembroke Listens: Pembroke Hill Road Community Conversation

Thank you for filling out this registration form. It is meant to help the organizers plan for the event. If you need any additional information, please feel free to contact Nik Coates at or Jennifer Jones at

* 1. Name (First and Last):

* 2. Physical Address (this is for planning purposes and will not be shared):

* 3. Email:

* 4. Number of Participants (including yourself):

* 5. Do you have any children in Pembroke schools?

* 6. What, if any, safety concerns about the Pembroke Hill Road intersection?

* 7. Are you familiar with the discussions about potential safety improvements at the intersection? Do you have any preferences of what should be done?