Tick Survey Request Form

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The Martha’s Vineyard Tick-borne Illness Reduction Initiative (aka the Tick Program) is dedicated to reducing the number of ticks and tick-borne illnesses on Martha’s Vineyard through education, advocacy and cooperation with other organizations and individuals. Thank you for your interest.

First Name *

Last Name *

Second Name (Caretaker)

Your email *

Your Second Name's email

Preferred phone number *

Secondary phone number *

Secondary phone number

Home street address *

Town *

Zip Code *

Address you receive mail *

Zip code of where you receive mail *

Do you live on the Island year-round? *

Yes

Other:

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