Fill out this form to register your group or call (252) 329-4522.

If you have any questions or need additional information, please contact the Public Works Recycling Coordinator at (252) 329-4522.

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1

Name of Group

 *

Name of Group

2

Name of Contact

 *

Name of Contact

3

Address of Contact

 *

Address of Contact

4

Phone Number

 *

Phone Number ext.

5

Fax Phone

Fax Phone ext.

6

Location of Project

 *

Location of Project

7

Number of Volunteers

 *

Number of Volunteers

8

Age Range of Volunteers

 *

Age Range of Volunteers

9

Scheduled Date of Clean-Up

 *

Scheduled Date of Clean-Up

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2. Email Address

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