ZEN Household Registration

Zero Emissions Network (ZEN)

The award winning 'Zero Emissions Network' (ZEN) helps businesses and residents save money, reduce emissions and improve air quality across Hackney, Islington and Tower Hamlets. The information you provide will be used to help us understand the issues most important to you. Your information will be used in line with Hackney Council's Privacy Policy.

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1. Your contact details

First Name

Second Name

Telephone

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2. Your household details

Household Address

Household Postcode

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3. How many people live at this address?

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4. Which borough is your household in?

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5. Your work contact details

Business Name

Telephone

Position held

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6. Are you interested in any of the following

	Yes	No	Maybe
Electric vehicles	Electric vehicles Yes	Electric vehicles No	Electric vehicles Maybe
Cargo-bikes	Cargo-bikes Yes	Cargo-bikes No	Cargo-bikes Maybe
Car Clubs	Car Clubs Yes	Car Clubs No	Car Clubs Maybe
Zero emissions taxis	Zero emissions taxis Yes	Zero emissions taxis No	Zero emissions taxis Maybe
Help to reduce energy bills	Help to reduce energy bills Yes	Help to reduce energy bills No	Help to reduce energy bills Maybe
'Dr Bike' sessions	'Dr Bike' sessions Yes	'Dr Bike' sessions No	'Dr Bike' sessions Maybe
Cycle Training	Cycle Training Yes	Cycle Training No	Cycle Training Maybe
'Fix Your Bike' Course	'Fix Your Bike' Course Yes	'Fix Your Bike' Course No	'Fix Your Bike' Course Maybe
Cycle parking facilities	Cycle parking facilities Yes	Cycle parking facilities No	Cycle parking facilities Maybe

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7. Would you like to be contacted by the Council's SHINE service for energy saving advice? This can cover behavioural advice, energy efficiency measures, supplier comparisons, eligibility for discounted bills and grants, energy debt support and more.

To help the team tailor your advice, please tick all of the following that apply to any member of your household. If you meet the eligibility criteria, you will be contacted with tailored advice.

Child under 5 years

Child aged 5-15 years

Aged 65 years or over

Has a registered disability

Has a respiratory or heart condition

Claims benefits

None of the above

I do not want energy saving advice

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8. How did you hear about the Zero Emissions Network?

Referred (please specify)

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9. Would you like to be added to our mailing list to receive updates about offers and events?

Yes