Event Registration

First Name *

Last Name *

Phone Number (XXX-XXX-XXXX)

Email *

State *

Zip *

Please answer this short questionnare:

I am a resident of Niagara County *

Yes No

I have read and acknowledged the list of acceptable and unacceptable items. *

Yes No

The material I will be bringing was generated in my home and not by a business or organization. *

Yes No

I have read and acknowledged that Latex Paint will not be accepted at this event. *

Yes No

I understand only one voucher/appointment per household. *

Yes No

How did you hear about the HHW Voucher program?

Online / Internet

Newspaper Ad

Mailer

Facebook

Poster

Radio

Word-of-Mouth

Other

Register for Niagara County Residential Household Hazardous Waste Voucher Program