Rescheduled 2019 KHB Day Registration

KHB DAY Supply and Tool Request

This registration form is for KHB DAY on Saturday, May 4, 2019.
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

- Area Code Phone Number

Address *

Your credit card information is required. All bellow items (except garbage bags) must be returned, including gloves and vests. An invoice will be issued for any damaged or missing tools, and the amount will be deducted from the credit card. KHB will discard the credit card information after tools are returned. A price sheet for tools and supplies will be provided upon confirmation on your request.
Credit Card Type *

MasterCard Visa
Credit Card Number *
Expiration Date *
CVC # *
3 Digits on the back
What District will your clean-up/project be in? *
Location of Clean-Up/Project *
Number of expected volunteers *
What will your project include? *

Litter Clean-Up Illegal Dumpsite Clean-Up Beautification Other
Please describe your project. *

KHB DAY Supply and Tool Request