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* 1. What is your first and last name?

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* 2. What is your email address?

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* 3. What is your phone number?

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* 4. What municipality do you live in?

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* 5. What is your County of Haliburton address?

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* 6. What is your mailing address?

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* 7. Are you a permanent or seasonal resident of the County? Seasonal includes any cottages or other non-primary residences.

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* 8. How did you hear about the FoodCycler program?

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* 9. How many people live in your household?

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* 10. How would you best describe your household?

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* 11. What type of household do you live in?

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* 12. Have you participated in a previous FoodCycler municipal pilot program? If yes, you will be contacted to discuss potential opportunities to upgrade your device. 

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* 13. Which FoodCycler model would you like to purchase for your household?

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* 14. 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.

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