Kenora 2024 100 RTKC: Registration Form

1
Full Name* This field is required.
First Name
Last Name
2
Email* This field is required.
3
Phone Number
4
If the phone number is a cell number, confirm if you would like to receive text message updates.(this is a possible pilot program this year)
Yes
5
Please choose the registration type:If the free Radon Test Kit option is at 0 left, please select Waiting List
6
The firehall staff are willing to deliver radon test kits, if you aren't able to pick one up.Check here if you would prefer delivery.
Yes, I would prefer my kit delivered to my home.
7
Please provide your address and any deliver instructions if you would like it delivered.
Huge
Large
Normal
Small
Ok
Ok
8
The Radon Information Session will be held on Monday, October 28 at 7pm. Please let us know if you would like to attend in person or online (zoom).
9
Additional comments:
Should be Empty: