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2. First Name*
3. Last Name*
5. Email*
6. Phone*
8. Organization/Businesss Name
10. Cleanup Date*
    -- Select One --6.1.2024 - Community Cleanup9.28.2024 - Community Cleanup12.7.2024 - Community Cleanup

    Cleanup Date you wish to participate in.

12. Cleanup Area or Location:*

    Please let us know what area or location you and your group will be cleaning.

14. Cleanup Time Frame:*

    Please let us know what time you will be at the cleanup location of your choice.

16. Amount of people in your group?*
19. Do you need supplies? *

    1. Yes
    2. No

    Cleanup supplies will be available for pickup at the Public Works Compound located at 52 Savannah Rd, Fort Pierce, FL 34982. 

    1. Wed. December 4th: 12:00 p.m. – 4:00 p.m.

    2. Fri. December 6th: 8:00 a.m. – 4:00 p.m.

    3. Sat. December 7th 8:00 a.m. - 12:00 p.m.

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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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