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* 1. Contact Information

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* 2. Are you collecting as an individual or part of a group (i.e. a business team or club)

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* 3. What is your preferred collection date (tick all that apply)

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* 4. Preferred collection time of day

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* 5. How long would you like to collect for

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* 6. Preferred collection area

PLEASE NOTE: We will confirm available times and locations with you as soon as we can. Not all locations are available for all three days.

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* 7. If you have any additional comments or questions please enter them below

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