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Roadside Trash Pickup Application
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Email
*
Your email
Date of request
*
MM
/
DD
/
YYYY
Name of Non-profit applying
*
Your answer
501(c)3 number
Your answer
Mailing Address
*
Your answer
EIN Number
Your answer
Contact Person Name
*
Your answer
Cell phone number
*
Your answer
Email Address
*
Your answer
Project Date
*
MM
/
DD
/
YYYY
Roads/Locations for litter pickup
*
Your answer
Estimate number of participants
*
Your answer
Application submitted by
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Your answer
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