KEEP IT CLEAN PROGRAM APPLICATION (PLEASE PRINT OR TYPE)

KEEP IT CLEAN PROGRAM

KEEP IT CLEAN PROGRAM

APPLICATION

(Please print or type)

Name of Sponsor/Organization_______________________________________________

Organization’s Purpose/Mission ___________________________________________

_______________________________________________________________________

Contact Person’s Name and Title __________________________________________

Address ________________________________________________________________

Day Phone _______________________ Evening Phone ________________________

Fax Number _____________________________________________________

Name or type of area interested in sponsoring (e.g. stream, open space, street name)

1st Choice:_______________________________________________________________

2nd Choice: ______________________________________________________________

PLEASE BE AWARE IT MAY NOT BE POSSIBLE TO RECEIVE THE AREA OF YOUR CHOICE: HOWEVER, WE WILL DO OUR BEST TO HONOR YOUR REQUEST.

________________________________________________________________________

Sponsor or Sponsor’s Agent

_____________________ _______________________________________________

Date Signature

Please return completed form to:

KEEP IT CLEAN

Auburn Hills Department of Public Works

Jeanetta Miller

Executive Assistant

1500 Brown Road

Auburn Hills, MI 48326

Telephone No. 248.391.3777

or fax to:

Fax No.: 248.391.4895