City of Victoria Form Center

2. Name of organization*
4. Report date*
   Report date
5. Contact person*
6. Phone number*
8. Cleanup location*
10. Hours worked*
11. Bags filled*
12. Do we need to arrange to have the bags and/or waste picked up?*

    1. Yes

    1. No
14. Other comments

    Thank you for helping to keep the City of Victoria beautiful!

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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

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