2. Pick It UP! Campaign Pledge Form

4. 
6. First Name
7. Last Name
9. Phone Number
10. Email Address
12. Preferred Social Media Platform, Handle
14. Address
16. City
17. State
18. Zip Code
22. Tell us how you will commit to the District 4 #PickItUP! Campaign Pledge!
    -- Select One --Pick up litter.Organize a clean up.

    Will place instructions here.

Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field