Let’s DO THIS!

To Be Determined

For more information contact:

Name (Name & Location will be shared on this page, the other information will be private)

First Name

Last Name

Area that was/will be cleaned up. If doing a road, give from intersection to intersection. Example: Harvey Point Rd from Pender Rd to Skinner Rd.

If clean up has already happened, do bags need to be picked up?

Yes - they are still on road

No - we took care of it ourselves

Address (House number, street, city, State, Zip)

Phone

(###)

###

####

Date of clean up

YYYY

Group Name (if any)

I have read the DOT Safety Rules and Guidelines

Yes