Special Event Litter Box Request

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

First NameLast Name
Address*

Street Address Line 2

CityState / Province

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

MonthDayYear
Date
Purpose and/or location of event*

Street Address Line 2

CityState / Province

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

Special Event Litter BoxesRecycling 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: 4.
Pickup Date and Time (if you don't see a time that works for your schedule, please call 901-636-4410 so that we can accommodate you):*
Drop-Off Date and Time*
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 Community Enhancement 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*

MonthDayYear
Date
Should be Empty:

Special Event Litter Boxes and Recycling Bins Loan Request