Email

Phone

Date of Cleanup Event

What type of cleanup event are you conducting? (Please choose all that apply)

Location(s) of Cleanup Event (park, waterway, roadway, etc.)

Estimated number of volunteers

Would you like the following supplies? (Please choose all that interest you.)

By checking the box below, you are agreeing to submit a wrap up report no later than TWO WEEKS after this event. The online wrap up report must be completed to ensure that future requests for supplies can be fulfilled.

I understand and agree to the above statement.

Supply Request