First Name:*

Last Name:*

Address 1:*

Address 2:

Postal Code:*

Home Phone Number (123-456-7900):*

Work Phone Number (123-456-7900):

Contact me by Email:*

Email:*

Comments:

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Personal information is collected for the purpose of responding to your request. The City of Surrey is collecting this information under s.26(c) of the Freedom of Information and Protection of Privacy Act. For questions regarding the collection of personal information please contact the Manager of Marketing and Communications, 13450 104 Avenue, Surrey, BC V3T 1V8  |  604.591.4011