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Warm homes clean air

Air Quality Survey - Tokoroa & Te Kūiti

Complete this survey to be in with a chance to win a free cube of firewood worth $170. 

Please answer as honestly as you can. The prize winner will be picked at random, so your answers will have no impact on your chances of winning. Your name and address are only requested so we know where to deliver the free firewood and will not be used for any other purpose.

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Demographic information

Select option
2.  

Age

3.  

Gender

4.  

Which ethnic group(s) do you identify with? Select all that apply.

5.  

Do you have and use a wood burner in your home?

* required