Well water testing registration

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Please use this Registration to let us know if you plan to attend an informational session on Wednesday Sept 29 and/or would like to pick up a well-water sampling kit, so we can order enough kits. We will send you information about a Zoom link or physical location (Town Hall or Library). There will also be a chance to drop off water samples for a Library Trustee to deliver to Concord for you.

I would like to attend the informational session about well water testing on Wednesday, September 29 at 6:30 pm. *

yes

I am interested but cannot attend on Sept 29th.

I would like to pick up a test kit from the library *

yes

Not sure until I learn more at the Information program

Name *

Phone *

Zip code *

Attendance preference (if by Zoom, you can pick up the sampling kit and form another day) *

In -person in Warner (Library or Town Hall depending on numbers)

By Zoom - please send me a link

Not attending, I just need a kit.

Probable plan for returning water sample for testing.

In -person on Oct 17 (location in Warner, TBD) for delivery

I need someone to pick it up from me

I will take my sample and payment to DES or elsewhere, myself

Clear selection

Payments and form (okay to check 2) *

I can provide a payment check and fill out the forms myself

I need help with payment ($85)

I need help with filling out forms

Required

Would you like a follow up session by DES about test results? *

Yes

Maybe (depends on test results)

Submit

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