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1. Full Name of Primary Contact (Required.)

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3. Phone Number of Primary Contact (Required.)

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4. Name of Church or Organization Representing (Required.)

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5. Does your church/organization plan to "own your block" or would you like to have a block assigned to you by the City of Memphis? (Required.)

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6. Address of Church or Organization (Required.)

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7. Role/Position of Primary Contact in the Church or Organization (Required.)

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8. What are the surrounding streets neighboring the location of your church/organization? (For example, your address is 125 N. main St. Surrounding streets neighboring 125 N. Main St., include Front St., Adams Ave., Poplar Ave.) (Required.)

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9. Approximately how many volunteers/participants do you anticipate bringing to your cleanup site? (Required.)

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10. Does your church/organization have the capacity to haul trash? (Required.)

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11. Additional comments or questions (Required.)

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