Butt Blitz Submission Form

Butt Blitz Submission Form

April 2022
Volunteer Information
Name *

First Name Last Name
What team are you on? *
Please provide your email address if you would like a submission receipt sent to your email.
example@example.com
Cleanup Information
Date *

Month Day Year
Date
Where did you do your Butt Blitz? *
City, Town or Region
Number of cigarette butts collected *
How many MINUTES were you collecting for? *
If you are submitting data on behalf of a group, please ensure you have the collective number of minutes spent picking up cigarette butts and the total number of butts collected by all volunteers.
Photo Submission
Please submit any photos you took at your cleanup that you'd like to share!

Cancel of
Do you consent to allowing A Greener Future use the submitted photos on our website, social media or other promotional material?

Yes I consent No I do not consent
Should be Empty:

Volunteer Information