Please enter your personal information below* Enter at least 2 responses.
	First Name   Last Name

	House Number*

	Street Name*

	Unit no.

	Community or Hamlet Holland Landing, Kleinburg etc.

	City or Town*
	--Please Select--AuroraEast GwillimburyGeorginaKingMarkhamNewmarketRichmond HillVaughanWhitchurch-Stouffville

	Postal Code*

	Please check which times you are available* Please be sure to check all of the days you are available. Due to popularity Saturday appointments take longer to book and may not be available until much later in the summer.
	Tuesday 12pm - 5pm    Tuesday 5pm - 7pm    Wednesday 12pm - 5pm    Wednesday 5pm - 7pm    Thursday 12pm - 5pm    Thursday 5pm - 7pm    Friday 9am - 5pm    Friday 5pm - 7pm    Saturday 9am - 5pm

	Please enter any exceptions (date/time)

	Telephone* Please enter a phone number, including area code, we can reach you so we can arrange a suitable time for the landscape visit.

	Email address We will only use your email address concerning this landscape visit appointment unless we receive permission from you to join our electronic mailing list.

	Would you like to be included on our electronic mailing list to receive future newsletters and information about upcoming Water for Tomorrow events through email?
	--None--Yes No

	How did you hear about the Water for Tomorrow landscape visit program? Select at least 1 response.
	Website    York Works    Advertisement in newspaper    Flyer in mail    Friend or neighbour    Community event    Local municipal office    Web search    Other, please specify