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Take The Pledge
Cleanup Kit Giveaway Entry Form
Enter for a chance to win a Cleanup Kit!
Each kit will include two grabbers, two safety vests, two sets of work gloves, and other goodies when available.
First Name
*
Last Name
*
Size safety vest and gloves preferred:
*
1 Medium & 1 Large
2 Medium
2 Large
Company Name, if applicable
Street Address for Shipping Kit (no P.O. Box)
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip
*
Is this a business or residential address?
*
Business
Residential
Phone (for delivery)
*
Email
*
What do you hope to accomplish with a Cleanup Kit?
*
How did you hear about the Cleanup Kit Giveaway?
*
eNews from KVB
Friend or Family Member
Social Media
While browsing KVB website
Other
If other, where?
If your name is chosen, we will contact you by email. Thank you for caring about our environment!
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