Yukon Honey Origins Participant Form

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The information collected will be used as part of this study and no personal information will be shared. The hive management and location data will be used in this study. A $50 fee is required to pay for supplies and help fund this project. Each Participant will receive a detailed NMR report and pollen profile for each submitted sample.

Name (First/Last) *

Email Address *

Date Sample Submitted *

YYYY

Apiary Setting *

Urban

Agricultural (Active)

Agricultural (Abandoned)

Rural Native (Low Soil Disturbance) Low property density (>15 acre lots)

Rural Native (High Soil Disturbance) High Property Density (<5 acre lots)

Other:

Location *

Atlin

Carcross

Carmacks

Dawson City

Faro

Haines Junction

Mayo

Mt Lorne

Tagish

Teslin

Watson Lake

Whitehorse

Quebec

Alberta

British-Columbia

Alaska

Other:

Getting Geo location of your apiary

Visit google maps and right click on your hive location (within 2 km please). Click Lat/Long number to copy it. Paste value below

Apiary Latitude / Longitude - Example (60.32705468743882, -134.46325979150328) *

Additional Comment to Describe Apiary Location

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