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.Format: (000) 000-0000.
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:
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
Date Signed

MonthDayYear
Date
Should be Empty:

Special Event Litter Boxes and Recycling Bins Loan Request