Clean Up Registration Form

Keep Brookhaven Beautiful - APRIL 17, 2010 EVENT

Great Brookhaven Cleanup

April 17, 2010 - Volunteer Registration Form

* denotes a required field

Registered User Name

First Name

Last Name

Your Email Address

RE-ENTER Email Address

Address 1

Address 2

City

State

Zip Code

Day Phone Number

Evening Phone Number

Cell Phone Number

Group/Organization

# Volunteers Participating

Location you are cleaning

View Staging Areas

Choose Staging Area
closest to your cleanup

Do you need additional workers ?

Can you recommend other
locations in need of cleanup ?

Are you a member of :

Adopt-A-Highway
Adopt-A-Spot
Adopt-A-Park
None of the above