Name of Group/ Organisation/Individual*: 

Key Contact(s) *: 

Please give us your contact details below, if we don’t already have these from you

email address: 

Telephone Number(s): 

Address: 

Post Code: 

Location of your grot spot(s) *:

 please give as much information as possible

Type of rubbish eg litter, flytip, other *:

How many people do you think would be needed to tackle the site in a 2 hour litter pick? *:

      1-2

    3-10

  11-25

Any other comments: