Your Government

Adopt-A-Roadside Program

Litter Pickup Form
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The adopter Representative shall organize a litter pickup work effort a minimum of four (4) times per year, at least once every three (3) month quarter, during the daylight hours. Failure to comply with this quarterly requirement shall result in termination of the Memorandum of Understanding for the Adopt-A-Roadside Program (as signed by Adopter Representative) and result in removal of the Adopt-A-Roadside recognition signs.

Adopter Name:*

Adopter Representantive:

Name:*

Address:

City:

State:

Zip Code:

Phone:*

Email:*

Adopted County Roadside:*

Limits of Adopted County Roadside:

From:*

To:*

Date of Litter Pickup:*

Comments:

Submittal

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