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* 1. Would your family like to be contacted with advice on reducing your energy costs and being energy efficient in your home?

If you tick yes, a representative of the Warm and Well North Yorkshire project will contact you about your home energy needs.

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* 2. Please provide the following details:

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* 3. Please tick any of the following that apply to you:

By providing your details above and submitting this form you are agreeing to us contacting you for the purpose of providing advice and support related to the Warm and Well North Yorkshire project. We will not share your information with any other third parties
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