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Clean Air Together - Application Form
*Required
To register, you need to:
Be over 18 years old.
Be able to install a small
NO
2
measurement tube at a location in Limerick City (address with a Limerick City Eircode within the Metropolitan District of Limerick City). This may be at your residence, workplace or community building.
Have access to a ground-floor or first-floor window facing a road at that location.
Be available to deploy and remove the tubes on specific project dates.
Please confirm that this is the case by answering "Yes" to the following question:
I fulfill the criteria for registration to Clean Air Together (Limerick City).
Yes
Age range (you must be over 18 to apply):
18-24
25-34
35-44
45-54
55-64
65+
18+ but not disclosed
Gender:
Female
Male
Prefer not to say
Other
Shipping Address:
Your measurement pack will be sent here if you are selected to participate. Look up your Eircode at
https://finder.eircode.ie/
.
Select County ...
Carlow
Cavan
Clare
Cork
Donegal
Dublin
Galway
Kerry
Kildare
Kilkenny
Laois
Leitrim
Limerick
Longford
Louth
Mayo
Meath
Monaghan
Offaly
Roscommon
Sligo
Tipperary
Waterford
Westmeath
Wexford
Wicklow
Measurement Location:
This is the location where you will deploy your
NO
2
measurement device. Look up your Eircode at
https://finder.eircode.ie/
.
Tick if the 'Measurement Location' is the same as the 'Shipping Address'
Select County ...
Carlow
Cavan
Clare
Cork
Donegal
Dublin
Galway
Kerry
Kildare
Kilkenny
Laois
Leitrim
Limerick
Longford
Louth
Mayo
Meath
Monaghan
Offaly
Roscommon
Sligo
Tipperary
Waterford
Westmeath
Wexford
Wicklow
Measurement location type:
Residence (house, apartment, flat)
Business (shop, pub, restaurant...)
Office
Other (please specify)
How did you hear about Clean Air Together (tick all the options that apply):
Social Media
National Newspaper
Local Newspaper
Radio
Project Website
Word-of-mouth
Youtube
Other (please specify)
Did you hear about Clean Air Together from an organisation? (tick all the options that apply):
An Taisce
Asthma Society of Ireland
Environmental Protection Agency
Other (please specify)
No, I didn't
I confirm that I have read and agree to the
terms & conditions
of the Clean Air Together project. I understand the basis for the collection and use of the personal data gathered in the application as described in these terms & conditions. The privacy policy for the Clean Air Together website may be read
here
. Please tick box to continue.
Submit my application to take part in the project!