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2. After each street clean up event, please fill out this form completely.
4. Please return unused supplies to the City's Community Development Building, 305 SW A Street, 2nd floor.
6. Participant Information
8. Organization Name:
10. Address:
12. Contact Person Information
14. Contact Name:
16. Email:
17. Phone:
19. Adopt-A-Street Assignment
21. Street Name:
22. Section:
24. Clean Up Event Details
26. Clean Up Date:
    Clean Up Date:
27. Number of Volunteers:
28. Volunteer Hours Worked:
29. Total Bags Collected:
31. Clean Up Event this Year:

    1. 1st
    2. 2nd
    3. 3rd
32. Location where filled trash bags were left for city crew to pick up:
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field