2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Email address*
15. Best phone number(s) to contact you*
17. Pick Your Level of Commitment*

    1. Commit to make a difference on my own street. Pick up litter while on my daily walk. Make sure my trash cans and recycling bins are secured, especially on windy days. Keep a litter bag in my vehicle.
    2. Commit to organize a neighborhood cleanup day. Work with city staff to organize.
    3. Commit to serve on the city’s litter patrol, picking trash in areas identified with the greatest need and organized cleanup events throughout the year.
    4. Commit to organize a group (scout troop, church, family, work) to pick up trash. (Please list group below)
    5. Other (explain below)
19. Please list group or tell us how you will help
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

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