1

Group Name

 *

Group Name

2

Group's Adopted Street

 *

Group's Adopted Street

3

FROM street/location

 *

FROM street/location

4

TO street/location

 *

TO street/location

5

Date of Cleanup

 *

Date of Cleanup

6

Number of Group Volunteers

 *

Number of Group Volunteers

7

Approximate Number of Hours Worked

 *

Approximate Number of Hours Worked

8

Approximate Number of Trash Bags Collected

 *

Approximate Number of Trash Bags Collected

9

Summary of what was accomplished at the cleanup

 *

Summary of what was accomplished at the cleanup

10

Next Anticipated Cleanup Date (requirement of 4 cleanups per year)

Next Anticipated Cleanup Date (requirement of 4 cleanups per year)

11

Feel free to upload a "before" cleanup picture here

Feel free to upload a "before" cleanup picture here Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

12

Feel free to upload an "after" cleanup picture here

Feel free to upload an "after" cleanup picture here Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

13

Feel free to upload a picture of your group here

Feel free to upload a picture of your group here Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

14

THANK YOU!  For all your hard efforts in helping to keep West Des Moines beautiful!

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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