http://www.123formbuilder.com/form-3471008/Contact-Lead-Form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This page is designed to allow you to contact us with your comments.  There are four categories from which to choose.  One category, "Medical" refers to people who have lived or live in Pompton Lakes.  If you fall into that category and are having medical issues, especially those that can be related to mercury or lead poisoning, or cancers or other illnesses related to TCE's or PCE's please take the time to fill out the form detailing your ailment.  We are endeavoring to build a database to present to the Department of Health to show the long term results of exposure to the toxins that were produced by DuPont when they were covering up their pollution of the town.  Your name and address will be kept strictly confidential.

 

 

Please provide us with your up-to-date contact information so that we can keep our address file current.

 

At present, the we are having problems with the online form.  Please submit information, including name, address, email and medical issues to sinsimer2@gmail.com.

The form should be back up within the next forty eight hours.

 

Thank you for your patience.

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