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Help us by reporting
your cleanup achievement
Please complete this form
Your data is important!
First Name
Last Name
Email
Team Name (if applicable)
Phone
Street Address
City
Zip code
Street Address Line 2
Type of cleanup event
choose cleanup activity
Number of participating adults
Number of hours (in whol numbers)
Date of cleanup
*
required
Number of participating children
Number of bags collected
Clean up location
choose your cleanup city/county
Brief description of cleanup location (street or park name)
Description and approximate quantities of the types of litter you found, i.e. 25 cans, 10 plastic bags, etc. (including exact number of tires (if any)).
Additional comments
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