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2. First Name*
3. Last Name*
5. Email*
6. Phone*
8. Organization/Businesss Name
10. Cleanup Date*
    -- Select One --6.7.2025 - Community Cleanup9.20.2025 - Community Cleanup12.13.2025 - Community Cleanup

    Cleanup Date you wish to participate in.

12. Cleanup Area or Location:*

    Please let us know what area or location you and your group will be cleaning.

14. Cleanup Time Frame:*

    Please let us know what time you will be at the cleanup location of your choice.

16. Amount of people in your group?*
19. Do you need supplies? *

    1. Yes
    2. No

    Cleanup supplies will be available on the following dates for pickup at the Public Works Compound located at 52 Savannah Rd, Fort Pierce, FL 34982.

    Wednesday, December 10th: 12pm - 3pm

    Friday, December 12th: 8am -3pm

    Saturday, December 13th: 7am - 12pm
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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