LNCT ADOPT-A-HIGHWAY REGISTRATION

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Please provide the information below to let us know you will help with LNCT's first Adopt-A-Highway event at 10:00 a.m. on EARTH DAY, APRIL 22, 2021.

We will pick up litter along Highway 101, just north of Wheeler, Oregon. Please meet at the intersection of Hemlock and Highway 101, at the north end of Wheeler.

When you arrive we will have a waiver and release form for you to sign before we begin the event, so please arrive 10-15 minutes early.

We will have safety vests, gloves, trash bags, and other necessary supplies. But if you have a pair of gloves, a grabber, or other items you want to use, you are welcome to bring your own. Please wear sturdy shoes because you will be on uneven surfaces.

Please remember that the most important priority during the event is SAFETY!!

Email *

First Name *

Last Name *

Email address *

Cell phone number *

Home address - Street number and street, or PO Box

Home address - City, State, Zip Code *

Are you a minor? (under 18 years old) *

Yes

Emergency contact person - Name

Emergency contact - phone number

Please check below if you would like to receive LNCT's monthly eBulletin/newsletter.

Yes, please sign me up to receive your monthly eBulletin.

No, please do not send me your monthly eBulletin.

Thank you, but no need. I am already receiving LNCT's eBulletin.

A copy of your responses will be emailed to the address you provided.

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