Do you find this newsletter to be informative regarding community issues?

• Yes
• No If no, why not?

Do you feel that Group 14621 is doing a good job of actively pursuing positive changes within the community?

• Yes
• No If no, why not?

Are you interested in participating in a block club?

• Yes
• No

Do you believe that lead poisoning is harmful to this community?

• Yes
• No

Would you like us to perform a FREE lead wipe test on your house to insure that neither you nor your children are exposed to lead hazards? If “yes,” write your name, address and phone number on the lines below. If “no,” leave blank.

• Yes, I am interested
  • Name
  • Address
  • Phone
• No, I am not interested

Would you be interested in volunteering to help administer lead wipe tests, so that we can provide a safer community for out residents? If “yes,” write your name and phone number on the lines below. If “no,” leave blank.

• Yes, I am interested
  • Name
  • Phone
• No, I am not interested

Please feel free to write any suggestions you feel this organization should address.