Basic Information

* 1. Please provide your full name.

* 2. Please provide your full home address.

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

* 4. Please provide your email address.

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

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

* 7. Do you carry out regular litter picks?

* 8. If yes, how frequently?

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

Thank you for completing this questionnaire.