Keep It Clean! 2009 Registration Form

Facilitated by Keep Greater Milwaukee Beautiful, Inc.

Information:
~Use this form to register and receive supplies for a cleanup or beautification event that will take place June 1st, 2009, or later.

~We are open for SUPPLY PICKUP on FRIDAYS from 9am - 3pm. (Address: 1313 W. Mount Vernon Ave., Milwaukee, WI 53233).

~TOOLS MUST BE RETURNED to our office the following MONDAY between 9am - 3pm.

~After the completion of your event, you must turn in a Wrap-Up Report (online) to be eligible to receive supplies in the future.

First Name

Last Name

Organization Name

Address

City

State

Zip Code

Day Phone Number

Alternate Phone Number

Receive Mass Email?

By checking this box I give Keep Greater Milwaukee Beautiful permission to send me program related emails and newsletters. I understand that my email will not be given or sold to anyone else for any other purposes.

E-mail

Birthday (mmddyy) optional if over 18

Name of Parent or Guardian if under 18

Check your preference for being contacted

E-mail

Phone

Postal Mail

Cleanup or Beautification Event Location

Beginning Date of Cleanup (Please enter as mmddyy -- numbers only, no spaces, dashes or commas)

Start Time of Cleanup

Estimated End Time of Cleanup

Estimated Number of Volunteers

Number of Bags Requested for Cleanup Event

Borrow A Tool Program (B.A.T. Program)
Please indicate the number of rakes, shovels and brooms you would like to borrow for your event.
~Open to City of Milwaukee Residents only
~Tools must be returned to our office on the MONDAY following your supply pickup (rental period is three days). Monday drop-off hours: 9am - 3pm.
~A copy of your Drivers License ID will be required as a deposit.
~Available while supplies last.

Leaf Rakes Requested

Round Point Shovels Requested

Square Point Shovels Requested

Brooms Requested

Please choose a FRIDAY (9am-3pm) to pick up supplies. (Please enter as mmddyy)
Example: "060509" would mean June 5th, 2009

How did you hear about Keep Greater Milwaukee Beautiful?

Is this your first time participating with Keep Greater Milwaukee Beautiful as a cleanup coordinator?

Note: A $10.00 voluntary donation fee is appreciated for any groups of 50 or more. Thank you!
Check can be made out to Keep Greater Milwaukee Beautiful
Address:
1313 W. Mount Vernon Ave.
Milwaukee, WI 53233-2620

Comments/Questions

As Coordinator, I agree to have participants sign in and to distribute cleanup supplies to the cleanup volunteers. I acknowledge and assume all responsibility and risk as a result of any Youth Volunteers who participate in my cleanup and agree to hold harmless Keep Greater Milwaukee Beautiful, Inc., its Director, Board, Staff, and volunteers from any and all liability resulting from their participation. I agree to return the Keep It Clean Wrap-Up Report and the Keep It Clean Volunteer Sign-In Sheets, along with any unused supplies to the KGMB offices within two weeks of our cleanup and I understand that if I fail to do so, KGMB may not be able to distribute supplies to myself or my group in the future.

Initials

Date (mmddyy)

BAGS AND OTHER ITEMS AVAILABLE WHILE SUPPLIES LAST.
Courtesy of Glad ForceFlex, in partnership with Keep America Beautiful, Inc.

Indicates Response Required