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2. Participant Information
4. Name (organization, business, family, etc.)
6. Contact Name
8. Email
9. Phone
11. Litter Clean Up Location *

    Select all that apply. 

    1. Trail
    2. City park
    3. Along the street
    4. Detention pond
    5. Creek bed
    6. Within a neighborhood
12. Location Name (trail name, park name, street section, neighborhood name, etc.)
14. Clean Up Event Details
16. Clean Up Date
    Clean Up Date
17. Number of Volunteers
18. Volunteer Hours Worked
19. Total Bags Collected
21. Location where filled trash bags were left for city crew to pick up
23. Photos

    If you feel comfortable doing so, please upload photos of the volunteers in action helping to protect the environment and beautify Bentonville. 

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field