Area Leader Report Form

 

You may fax this form to Richard Mazzucchelli at 703-777-9523 or mail it to him with your photos at 38739 Mt. Gilead Road, Leesburg VA 20175. If you have questions about this form, please contact Richard at 703-777-8882 or rjmazzucchelli@aol.com.

 

Submitted by

Area Leader's name

Area

Address

Phone

Email

How many miles of road were cleaned in your area?

How many volunteers were involved?

Total volunteer hours (number of volunteers multiplied by the number of hours worked):

Total # of bags

Total # of tires

Total # of heavy appliances

Total other

Describe other items you picked up:

Organizations that helped: (Scouts Troop #, Churches, etc.) Please include your point of contact for that organization along with their address and phone number so we can send them their award checks.

Did you do any special projects?

Were there any problem areas we should know about?