2021 Great American Cleanup Registration

THE GREAT

AMERICAN

CLEANUP

Contact Name*

PrefixFirst NameLast Name

Name of Company, Organization, Club, Business, Neighborhood, School, Family, or Individual*

Estimate Number of Adult Volunteers (18 years or older)*

Estimate Number of Young Adult Volunteers (ages 13-17)*

Estimate Number of Child Volunteers (12 and under)*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Preferred Contact Phone Number*

Area CodePhone Number

YesNo

Please specify your selected cleanup site by listing the name of the waterway, lake, neighborhood, park, school, street(s), etc.

Please let us know what part of the City you would like to help clean up. We'll help find you and your group the perfect site!