Town of Wainwright - FoodCycler Pilot Program Registration Form
Participants in the FoodCycler program will be selected on a first come first served basis
. You will be contacted if you are selected to participate.
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1.
What is your first and last name?
(Required.)
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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.
Which FoodCycler model would you like to purchase for your household?
(Required.)
FoodCycler Eco 3 ($200 + Tax)
FoodCycler Eco 5 ($300 + Tax)
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7.
I consent to the Town of Wainwright contacting me if I am eligible to participate in the program
(Required.)
Yes
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8.
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.)
Yes