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2. Name*
3. Name of Family/Organization You Represent

   You do not have to be part of an organization to participate in this event.

5. Email Address*
6. Daytime Phone Number on Event Day*
8. Street Address & Zip Code of Cleanup*

   Only Hampton locations are eligible for participation in this event.

10. Day(s) You Will Be Walking*

    Check all that apply.

    1. March 24
    2. March 25
    3. March 26
    4. March 27
    5. March 28
    6. March 29
    7. March 30
    8. March 31
    9. April 1
    10. April 2

    1. April 3
    2. April 4
    3. April 5
    4. April 6
    5. April 7
    6. April 8
    7. April 9
    8. April 10
    9. April 11
    10. April 12

    1. April 13
    2. April 14
    3. April 15
    4. April 16
    5. April 17
    6. April 18
    7. April 19
    8. April 20
    9. April 21

    1. April 22
    2. April 23
    3. April 24
    4. April 25
    5. April 26
    6. April 27
    7. April 28
    8. April 29
    9. April 30
12. Approximate Starting Time of Your Walk*
    Approximate Starting Time of Your Walk
13. Name of Street(s) or Area You Plan to Walk*
14. Starting Point*
15. Ending Point*
17. Cross Streets Where Trash Bags Will Be Picked Up*

    If you are putting the trash in your container type in NA.

18. Approximately How Many People Will Be Walking With You?*
20. Disposal of Trash Bags*

    1. I will put bags in my trash can.

    1. Please pick up bags at cross streets indicated below.
22. Will You Need Equipment?*

    1. Yes

    1. No

            Pickup/drop off equipment at Clean City Office

23. If equipment is needed, click on this link
    Clean City AAS Supply Request Form
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field