Coordinator Name * Position/Title * Organization Name Street Address *
City * State * Zip Code * Phone Number (Work)
Phone Number (Home) Phone Number (Cell) Email Address *  
I provide my permission to Prince George’s County, Maryland to publicize my organization name, contact number and email address on the web page for any interested
volunteers to join our group for this event.
Block Number   Name of Street  
_Hundred Block of_

Who owns the site(s)? *        
Do you have permission from the property owner or school principal to enhance the site?      
From whom did you receive permission?        
First Name Last Name Position Phone Number Email Address
Please request a letter of permission from the owner and have onsite the day of the event.
Number of Volunters * Bags of Mulch (max. 8) *
First Name Last Name Email Address Attending Picnic Shirt Size  

Total Shirts

Small Medium Large Extra Large 2XL
0 0 0 0 0