Cleanup Complete Form
To be completed AFTER your Adopted Road Cleanup Event
Submit
Adopt- A- Road Group:
Contact Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Adopted Road
Date of Cleanup
-
Month
-
Day
Year
Date
Roadway Name
Location of Collected Trash
Number of volunteers
Bags of trash
Hours spent
Description of Cleanup
Miles Cleaned Up
Picture of collected Trash
Browse Files
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Choose a file
Cancel
of
File Upload
Browse Files
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Choose a file
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Should be Empty: