Special Event Litter Box Request

Special Event Litter Boxes and Recycling Bins Request
Your Information
Organization *
Responsible Party *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Event Information
What was the date of your event? *

Month Day Year
Date
Address of event *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Expected attendance *
Box and Bin Needs
I would like to request: *

Special Event Litter Boxes Recycling Bins
How many special event litter boxes would you like? *
Maximum: 10. If you need more, please call 901-636-4410.
How many recycling bins would you like? *
Maximum: 5.
What day will you pick them up from Memphis City Beautiful? *

Month Day Year
Boxes/bins can be picked up Mondays, Thursday, and Fridays.
What time will you pick them up? *

Hour Minutes

AM/PM Option
What day will you drop them off? *

Month Day Year
Boxes/bins must be returned the next open day following your cleanup/project.
What time will you drop them off? *

Hour Minutes

AM/PM Option
Do you have any additional comments about your request?
Agreement and Waiver
I agree to hold the City of Memphis Government, including the Division of Public Works - Neighborhood Improvement and/or Memphis City Beautiful harmless in the event of any accident or injury by negligence or otherwise that I may suffer while utilizing the Special Event Litter Box Loan Program.
Responsible Party Signature *

Clear
Date Signed *

Month Day Year
Date
Should be Empty:

Special Event Litter Boxes and Recycling Bins Request

Your Information

Event Information

Box and Bin Needs

Agreement and Waiver