Please complete the following form and click SUBMIT to send us your registration. 

Your privacy is important to us.  Your information will only be used for the Litter. It Costs You program and related supporting programs.  If you have any questions, please contact

Sarah Visser
Keep Georgia Beautiful,
Dept. of Community Affairs
Email: svisser@dca.state.ga.us 

 

*Name of Organization:
*Type of Organization:
Category:	Business Individual Non-Profit
*Address:
Address 2:
*City:
*State:	Alaska Alabama Arkansas Arizona California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
*Zip
Adult Contact
*First Name:
*Last Name:
*Phone Number:
*Email:
Student Contact
First Name:
Last Name:
Phone Number:
Email:
*Where will the YCCC activities take place? CityCounty
*What city or county will they take place in?
*Number of students involved in the effort?
*Level: ElementaryMiddle/High School
*How did you hear about the Challenge? YCCC Poster Internet Local KAB Affiliate Teacher Garden Club Other...  Other description:

*Indicates Required Field