Constant Contact Sign-Up

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If you are a Town of Florence resident or property owner, you can use this form to sign-up to receive e-mail and SMS text messages from the Town regarding Elections, Garbage & Recycling, Town Roads, etc.

Please Note: This is for Town of Florence residents and property owners. If you are in a different Township, you may not be able to complete this form.

First Name *

Last Name *

Fire Number *

Fire Number for the address where you are signing up for notifications

Road Name *

Please choose your road name from the following list of names. Note: this list contains the names of public and private roads in the Town of Florence only. If your road name does not appear on this list, your address may not be in the Town of Florence. The easiest way to determine if you are Florence resident/property owner is to look at the physical fire number posted on your property. It will identify the Town that your property is in.

Cell Phone Number *

Cell phone numbers are collected for the purpose of sending SMS Text message reminders. Note: SMS text messages are limited to only 160 characters, so when a SMS message is sent, a more detailed e-mail will also be sent to your e-mail address containing more information.

E-mail Address *

The above cell phone numbers are collected for the purpose of sending SMS Text message reminders. Note: SMS text messages are limited to only 160 characters, so when a SMS message is sent, a more detailed e-mail will also be sent to your e-mail address containing more information.

Election Reminders *

I would like to receive notifications for the following Election Reminders:

when there is a February Primary Election

when there is an April Spring Eleciton

when there is an August Primary Election

when there is a November General Election

when there is a special election (this would be a rare occurence)

of the polling place hours the day before an Election

when in-person absentee voting begins

I do not wish to receive Election Reminders

Required

Garbage & Recycling Reminders *

I would like to receive notifications for the following Garbage/Recycling Reminders: (these reminders will be based on your address submitted above)

when there is a pick-up date change (when it falls after a holiday)

when weather or an equipment breakdown requires the pickup date to be changed to the following day

when the material drop off site opens for the year

when the material drop off site closes for the year

when spring weight limits will be put on (and removed) for the year if it impacts my garbage and recycling pickup

I do not wish to receive Garbage and Recycling Reminders

Required

Town of Florence Road Reminders *

I would like to receive notifications for the following Town Road Reminders: (these reminders will be based on your address submitted above)

when there will be road closures due to road construction

when spring weight limits will be put on (and removed) for the year

I do not wish to receive Town Road Reminders

Required

Express Permission *

By clicking the boxes below, you are agreeing and giving consent to the Town of Florence for express permission to send you e-mail/SMS text reminders.

e-mail permission

SMS text permission

Required

Name Confirmation *

Please type the name of the person completing this form for name confirmation of who is submitting this request.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms