JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Bag the Butts Registration
Thank you for being part of the solution for our community! Please sign a TEAM up below.
TEAM Captains will be contacted with further instructions.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name of your TEAM?
*
Your answer
TEAM Captain's Name (First & Last Name)
*
Your answer
TEAM Captain Phone Number
*
Your answer
Your preferred first choice park/city to "bag the butts"?
*
Your answer
Your preferred second choice park/city to "bag the butts"?
*
Your answer
Please list names of TEAM members and their t-shirt sizes*. *T-shirts are available while supplies last; please denote adult or youth size.
*
Your answer
Would you like a litter grabber if available?
(we request that these be returned with your tobacco litter)
*
Yes
No
How did you hear about the event?
*
TEAM Newsletter
TEAM Staff
Facebook
Twitter
Other:
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of CHI Health Midlands.
Report Abuse
Forms
