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1. Your Name: (Optional)

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2. When did your activity take place? (Required.)

Date

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3. If your activity is linked to a Cleanup hub, what is the name of the Cleanup Hub linked to this activity? (Required.)

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4. What is the name of your local council / local authority area? (Required.)

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5. Please select your role in today's activity: (Required.)

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6. Which activity did you participate in? Select all that apply. (Required.)

T