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2. Street Type:*
   -- Select One --Adopted StreetsNon-Adopted Streets
3. Proposed Clean-Up Date:*
   Proposed Clean-Up Date:
5. Street:*
6. Organization:
8. Contact Person First Name*
9. Last Name*
11. Phone:*
12. Email:*
14. Expected Number of Adult Participants:*
15. Expected Number of Child Participants:*
17. Location of Street Section to be Cleaned:*

    (If possible, provide names of road crossings and/or attach a map)

19. Map Location from City/County Road Map (If Available):
21. Preferred Tool Pick-Up Date:*
22. Central Meeting Place for Volunteers:*
24. Landowner Permission:*
    -- Select One --YesNoNot Applicable

    Have you obtained permission from landowners with property in the proposed cleanup area?

25. Have You Planned a Safety Meeting Before the Event?*
    -- Select One --YesNo
27. Additional Comments
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field