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2. WaterWise Community Captain Outreach Materials Form
   Educational materials and resources are available to help reach your neighborhood outreach goals. Use this form to request materials from the Water Resources Division. To register with the program, see this form.
3. 
5. First Name*
6. Last Name*
8. Phone Number*
10. Email Address*
12. I am interested in receiving the following printed materials:

    1. Community Captain Door Tags
    2. New Resident Flyers

    1. Water Quality Reports
    2. WaterWise Workshop Flyers
14. Community Captain Door Tags
    Amount Requested.
15. New Resident Flyers
    Amount requested.
16. Water Quality Reports
    Amount Requested
17. WaterWise Workshop Flyers
    Amount Requested
19. Community Captain Door Tag
    Date when needed
20. New Resident Flyers
    Date when needed
21. Water Quality Reports
    Date when needed
22. WaterWise Workshop Flyers
    Date when needed
24. I Am Interested in Receiving the Following Promotional Items:

    1. Soil Moisture Meters
    2. Toilet Leak Detection Tablets
    3. WaterWise Tote Bags
26. Soil Moisture Meters
    Amount Requested
27. Toilet Leak Detection Tablets
    Amount Requested
28. WaterWise Tote Bags
    Amount Requested
30. Soil Moisture Meters
    Date when needed
31. Toilet Leak Detection Tablets
    Date when needed
32. WaterWise Tote Bags
    Date when needed
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field