Basic Information

Please provide your full name.

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* 1. Please provide your full name.

Please provide your full home address.

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* 2. Please provide your full home address.

Please tell us your Ward (if known).

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* 3. Please tell us your Ward (if known).

Please provide your email address.

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* 4. Please provide your email address.

Please provide your home telephone number or your mobile number.

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* 5. Please provide your home telephone number or your mobile number.

Are you happy for your details to be passed on to your local Ward Councillor?

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* 6. Are you happy for your details to be passed on to your local Ward Councillor?

Do you carry out regular litter picks?

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* 7. Do you carry out regular litter picks?

If yes, how frequently?

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* 8. If yes, how frequently?

In which area/street to you litter pick?

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* 9. In which area/street to you litter pick?

Thank you for completing this questionnaire. 

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