Port Tobacco River Health Survey

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Select Your Zip Code* This field is required.

20677 (Port Tobacco)

20646 (La Plata)

20601 (Waldorf)

20602 (Waldorf / St. Charles)

20675 (Pomfret)

4

How important is the health of the Port Tobacco River to you?* This field is required.

Very Important

Somewhat Important

Not Very Important

5

How often do you spend time near or on the Port Tobacco River?* This field is required.

Frequently

Occasionally

Rarely

Never

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

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

9

Optional: Do you have any other health concerns with the Port Tobacco River?

10

Would you like to receive occasional updates about PTRC events, activities and initiatives?* This field is required.

Yes

No

11

Please verify that you are human* This field is required.