Worm Bin Request Form

Worm Bin Request Form

Name*

Email*

Phone number*

Workshop and Webinar

Did you attend/watch the worm bin composting workshop/webinar?

Select

How would you rate the worm bin webinar?*

Overall, on a scale of 1-10, 10 being the most informative.

Select or enter value

What types of food waste composting do you do?

Worm bin

Compost bin

Green curbside organics cart

Other

Spreading the word*

Are you interested in becoming a trained volunteer to spread the word about composting / reducing / reusing / recycling?

Yes

I certify that I am a resident of Clark County, WA*

I certify.

Pledge*

By Checking this box you pledge to reduce the amount of food waste going into the garbage (and to the landfill) by properly processing food waste.

I pledge.

The best day/time(s) for you to pick up your bin.*

M-F Mornings or Afternoon, or I'm flexible.

How did you hear about the worm bin offer?*

Select

Liability Waiver**

By checking this box, I am voluntarily participating in this activity. I understand that the views and opinions expressed at the event will be solely the speakers’ and not those of Clark County. I agree to indemnify and hold harmless Clark County against any claims, losses, expenses or damages that may be incurred as a result of any presentation. I also agree that the use of any materials prepared by a speaker will not expose Clark County to liability for breach of confidence for infringement of copyright or similar liability.

I agree.

Send me a copy of my responses

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