Register for the program here!

First and Last Name *

Email address *

Physical Address *

Postal code *

Phone Number *

Please select which FoodCycler Model you would like to purchase for your household *

* 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

Personal information provided on this form will be used strictly to facilitate contact. This information is collected under the authority of Section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act and will be protected under Part 2 of the Act. Questions regarding the collection and/or use of this information may be directed to the Records Management & FOIP Coordinator at foip@blackfalds.ca or by phone at 403.885.6370.

* - denotes required field