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2. Group or Organization Name:*
4. Street Segment:
5. Team Leader Name:*
7. Team Leader's Phone Number:*
8. Team Leader's Email Address:*
10. Date of Cleanup Event:*
    Date of Cleanup Event:
11. Number of Participants:*

    *Note: Supplies provided for a maximum of 15 participants.

12. When would you like to pickup supplies? (Please allow for a 3-day notice) *Must be during our office hours**
    When would you like to pickup supplies? (Please allow for a 3-day notice) *Must be during our office hours*

    When would you like to pickup supplies? (Please allow for a 3-day notice) *Must be during our office hours*

    *Note: Public Works Office Hours are Mon-Thru 7:00AM-4:30 PM, Fri 7:00AM-11:ooAM

    *Pickup Location: Public Works Service Center 10165 CR 106, Celina, TX

    
    

14. Special Request/Questions/Comments/Concerns/Additional Information:
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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

* indicates a required field