Town of Gibbons - FoodCycler Pilot Program Registration Form

Participants in the FoodCycler program will be selected on a first come first served basis. Registering for the program here does not guarantee your spot in the program. You will be contacted if you are selected to participate. 
 
1.What is your first and last name?(Required.)
2.What is your email address?(Required.)
3.What is your phone number?(Required.)
4.What is your civic address?(Required.)
5.What is your postal code?(Required.)
6.Which FoodCycler model would you like to purchase for your household?(Required.)
7.I acknowledge that by participating in this pilot program and obtaining a municipally subsidized FoodCycler, I am required to track usage for 12 weeks and complete of a brief exit survey about my experience with the program.(Required.)