Adopt-a-Highway - Application

  *required
 
  Individual/Organization
 

  *Name
  *City
  *Address

  *ZIP
  *Estimated no. of people per clean-up
  *County
 
  Authorized Representative
 

  *Name
  *City
  *Address

  *ZIP
  *Email
  *County
  *Phone

format: (555) 555-1212
  *Best time to contact
 
  Alternate Representative
 

  *Name
  *City
  *Address

  *ZIP
  *Email
   
  *Phone

format: (555) 555-1212
  *Best time to contact
 
  School/College Representative
 

  If you are part of a high school or college organization, you must include the following contact information for your faculty sponsor.
  Name
  Email
  Phone

format: (555) 555-1212
 
  Roadway Information
 

  *Request a stretch of highway

eg: U.S. 290 between Austin and Johnson City
  *Request an alternate stretch of highway

eg: U.S. 290 between Austin and Johnson City
  *County
 
  Questions/Comments
  Please send me Don't Mess With Texas updates.