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2. Please complete the online form below to be placed on the wait-list.
   Rancho Santa Margarita residents are eligible to receive one SHARPS container per month. Please fill out the information below and the City will contact you when a box is available and will set up a date and time for you to come and collect your SHARPs container.
4. *Please bring ID or verification of residency in the City of Rancho Santa Margarita at pick-up
6. Contact Information
8. First Name*
9. Last Name*
11. Address1*
13. Address2
15. City*
16. State*
17. Zip*
19. Contact Number*
20. Email Address*
22. Additional Information:
    The SHARPS container is a pre-paid postage box. There is paperwork attached to the side of the box in a Ziploc bag that must be filled out before dropping off the filled box at a post office. Rancho Santa Margarita residents CANNOT bring their filled SHARPS disposal box back to City Hall. The SHARPS Disposal container must be scanned/recorded at the treatment facility prior to receiving a new one.
23. Are you a Resident of Rancho Santa Margarita (Please choose one only)*

    1. Yes
    2. No
25. Please Specify Any Additional General Inquiry
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

* indicates a required field