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2. Name*
3. Email Address*
5. Address
7. City
8. State
9. Zip Code
11. Phone Number*
13. Are you a resident of Middle Smithfield Township?

    1. Yes
    2. No
15. Have you participated in 1000 Feet of Street or Pick Up the Poconos in the past?

    1. Yes, 1000 Feet of Street
    2. Yes, Pick Up the Poconos
    3. Yes, both events
    4. No, I'm new to volunteering for litter pickup
17. How many people are you signing up?*
    -- Select One --12345+

    Number includes the person completing this form and anyone they plan to bring with them to the event.

19. Are you signing up to clean up litter on Saturday September 23, 2023 starting at 8am?*

    1. Yes, I am
    2. No, I want to clean up on a different date

    If NO, please elaborate below, OR contact Chris Rain at 570-223-8920 x119 or crain@mstownship.com to arrange another date to do your litter cleanup.

21. Comments, including alternative dates to do your cleanup:
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field