Tobacco Litter Cleanup Submission Form

Say What! Resources

Tobacco and vape trash aren’t just litter, it’s toxic waste that’s hurting our environment. Complete the form below to host your own tobacco litter cleanup in your community. Then, we’ll send you supplies and community service hours for doing your part to help keep a clean environment.

Contact Information

First Name:

Last Name:

Type:

Email:

Phone Number:

(Optional)

Group Information

Youth Group/Organization Name:

School Name:

School District:

City:

Project Information

Cleanup Date:

Cleanup Location:

Will you be collecting litter with anyone else?

Yes

Gloves and Litter Bags

Check this box if you’d like to receive gloves and litter bags for your cleanup project.

Please fill out the mailing information to receive gloves and litter bags for your tobacco litter cleanup.

Street Address:

Apt/Suite:

City:

State:

Zip Code:

Email:

Please ensure all required fields are complete before clicking Submit.