You can always press Enter⏎ to continue
Port Tobacco River Health Survey
Open to Residents of Port Tobacco, La Plata, Waldorf, St. Charles and Pomfret. Complete the 2-minute survey and be entered to win a pair of Apple AirPods!
11
Questions
START
1
Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Email
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
3
Select Your Zip Code
*
This field is required.
20677 (Port Tobacco)
20646 (La Plata)
20601 (Waldorf)
20602 (Waldorf / St. Charles)
20675 (Pomfret)
Previous
Next
Submit
Press
Enter
4
How important is the health of the Port Tobacco River to you?
*
This field is required.
Very Important
Somewhat Important
Not Very Important
Previous
Next
Submit
Press
Enter
5
How often do you spend time near or on the Port Tobacco River?
*
This field is required.
Frequently
Occasionally
Rarely
Never
Previous
Next
Submit
Press
Enter
6
What activities are you most likely to enjoy on the river? (select all that apply)
*
This field is required.
Boating
Swimming
Fishing
Waterfront Dining
Bird Watching
Hiking
Other
Previous
Next
Submit
Press
Enter
7
Does your residence have a septic system?
*
This field is required.
Septic systems in the watershed can have a major impact on river health.
Yes
No
Not sure
Previous
Next
Submit
Press
Enter
8
When was your septic system last pumped out?
*
This field is required.
Proper septic care is essential to keeping our river clean and thriving.
0 to 3 years ago
3 to 4 years ago
4+ years ago
Not sure
Previous
Next
Submit
Press
Enter
9
Optional: Do you have any other health concerns with the Port Tobacco River?
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
10
Would you like to receive occasional updates about PTRC events, activities and initiatives?
*
This field is required.
Yes
No
Previous
Next
Submit
Press
Enter
11
Please verify that you are human
*
This field is required.
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
11
See All
Go Back
Submit