DRINKING WATER TESTING CLINIC WAIT LIST

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Please leave us your contact information so we can provide you with more information about the next drinking water testing clinic offered for Culpeper, Fauquier, and Rappahannock Counties.

Email *

First Name *

Last Name *

Mailing Address *

City, State and Zip Code *

Phone Number *

COUNTY property is located: *

Culpeper

Rappahannock

Fauquier

If other, please go to next question

If County is other, please specify which county property is located in:

Virginia Cooperative Extension is a partnership of Virginia Tech, Virginia State University, the U.S. Department of Agriculture, and local governments. Its programs and employment are open to all, regardless of age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race, religion, sexual orientation, genetic information, military status, or any other basis protected by law.

If you are a person with a disability and desire any assistive devices, services or other accommodations to participate in this activity, please contact Ashley Appling (540-727-3435/TDD*) during business hours of 8 a.m. and 5 p.m. to discuss accommodations 5 days prior to the event. *TDD number is (800) 828-1120.

A copy of your responses will be emailed to the address you provided.

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