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2. First Name
3. Last Name
5. Business, School, Organization, Group Name*
7. Address
9. City
10. State
11. Zip Code
13. Phone Number*
14. Email Address*
16. # of Volunteers*
17. # of People Reached*
18. Select The Event Type/Types*

    1. Educational Fair
    2. Litter Prevention/Cleanup
    3. Adopt-A-Spot
    4. Adopt-A-Highway
    5. Adopt-A-Block
    6. Adopt-A-Campus
    7. Reduce Waste/Recycling
    8. Tradeshow
    9. Sustainability
    10. Environmental
    11. Beautification
    12. Other
19. If Other, Please Specify
21. Select The Items Needed*

    1. Garbage Bags
    2. Gloves
    3. Trash Grabbers
    4. Clear Recycle Bags
    5. Recycle Containers
    6. Promo Items/Merchandise
    7. Bug Spray
    8. Sanitizer
    9. Masks
    10. Other
22. If Promo Items OR Other, Please Specify The Items Needed
23. Please Provide The Quantity/Quantities Needed:*
25. AVAILABLE PICK UP TIMES: Wednesdays & Fridays 9am - 11am & 2pm - 4pm.
    AVAILABLE PICK UP TIMES: Wednesdays & Fridays 9am - 11am & 2pm - 4pm.

    AVAILABLE PICK UP TIMES: Wednesdays & Fridays 9am - 11am & 2pm - 4pm.

    Please Note:  

    • 1) We will let you know once your request is ready. Fulfillment is based on availability. 
    • 2) Supplies Will only Be Held For 3 Days, Unless Notified Otherwise. 
26. Important Things To Remember
    • Be safe
    • Stay hydrated
    • Dispose bags of litter collected:  Use trash containers in/around your Adopt-A-Spot location. If no trash can is available, an arrangement for pickup must be made a week prior to your clean up.
    • Take before and after pictures. Tell your story, submit your pictures.
    • Submit your clean up. We cannot tell the amazing job our community is doing to keep it safe, clean and beautiful without a report. (add the link)
28. Do you need a KOB Representative to attend and be present at your event? If so, please provide details.
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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