NC Residents - Complete the survey and enter your name and address
to receive a free radon testing kit.

How did you hear about the free radon test kits?

What year was your home built?

Does your home have a...
(Check all that apply)
Basement
Crawl Space
Slab Foundation
Don't Know

Type of water supplied to home? Private Well
Community Well
City/County Water
Don't Know

Are there children living in the home on a permanent basis? Yes
No

Have you tested your home for radon before? Yes
No
If yes, when?

Are there any Smokers in the home? Yes
No

Receipient Information
Name:
Street:
City:
State:   Zip:
Email: