Adopt A Road Application

* Required field! Please fill in the correct information.

Name of Organization:
Contact Person: *
Phone: *
E-mail: *
Address to which future information should be mailed (if different from above):
**Location of desired clean-up road or site:
**Date of requested project start up:
 [None] Select a Date Delete the Date  
**Schedule of road cleanups (ie. one per month):
**Note: The Clean Communities Coordinator tries to match every group with their
  desired location or one nearby. However, if the requested road or site
  is already adopted, another road or site will be assigned.
How would you describe your organization:
Number of total participants: Kids
Additional Comments:


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