District of Mackenzie - FoodCycler Pilot Program Registration Form

The District of Mackenzie FoodCycler program is currently full. We encourage you to register for the waitlist and will contact you if spots become available.
 
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 postal code?(Required.)
5.Which FoodCycler model would you like to purchase for your household?(Required.)
6.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 of a brief exit survey about my experience with the program.(Required.)