Litter Cleanup Registration Form

Litter Cleanup Registration Form
Litter Cleanup Event:
Name *

First Name Last Name
I am signing up for (please check one) *

a group, club, or organization my family myself Adopt-A-Street Partner Adopt-a-Stream Partner
Group, Organization or Neighborhood
Estimate # of adult volunteers (18 and older) *
Estimate # of youth volunteers (under 18) *
Do you have a cleanup site? *

Yes No
We can help!

Click on the link for the litter map below to select from the available cleanup sites. Sites indicated by a red marker are available.

Litter Map
Please specify the location of your selected cleanup site by listing name of street, intersection, neighborhood, school, stream, etc.
Please list the date of your cleanup:

Month Day Year
Date
Email *
example@example.com
Event Day Phone *

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State

Zip Code
Should be Empty: