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Tell us about your organization
If you are a new Executive Director, please complete the
New Executive Director- Role and Available Resources Survey
.
Registration Type
*
- Select a value -
I am a Keep America Beautiful affiliate
I am a non-affiliate registering or reporting for a Keep America Beautiful program
Please tell us what type of organization you are.
Your affiliate name
Your role within the affiliate organization
- None -
President
Chairman
Executive Director
Board Member
Staff
Intern
Grant Writer
Other
Please describe your role
Which answer most closely matches your position based on average hours per week?
- None -
Non-profit Full-time paid affiliate only (40 hours)
Non-profit Part-time paid affiliate only (20-40 hours)
Non-profit Part-time paid affiliate only (less than 20 hours)
Government Full-time paid affiliate only (40 hours)
Government Part-time paid affiliate only (20-40 hours)
Government Part-time paid affiliate only (less than 20 Hours)
Government paid with affiliate duties "as other duties as assigned" (40 hours)
Government paid with affiliate duties "as other duties as assigned" (20-40 hours)
Government paid with affiliate duties "as other duties as assigned" (less than 20 hours)
Volunteer 40 hours
Volunteer 20-40 hours
Volunteer less than 20 hours
Organization type
*
- Select a value -
Civic Organization
Material Recovery Facility
Municipality
Non Profit
Recycling Organization
College/University
K -12 school
For profit company
Local government agency
State or federal govt. agency
Religious organization
Native America tribal government
Other
Organization name
What department do you work in?
Do you have a Keep America Beautiful affiliate in your community?
*
- Select a value -
Yes
No
I don't know
Please Enter Affiliate Name
Tell us about yourself
Picture
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256 MB
.
Allowed file types:
png gif jpg jpeg
.
Name
*
Title
--
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
First
*
Middle
Last
*
Address
Country
*
Bahamas
Canada
Puerto Rico
United States
Address 1
*
Address 2
City
*
State
*
- Select -
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
--
Armed Forces (Americas)
Armed Forces (Europe, Canada, Middle East, Africa)
Armed Forces (Pacific)
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
Virgin Islands
ZIP code
*
Separate mailing address?
Mailing Address
Country
- None -
Bahamas
Canada
Puerto Rico
United States
Address 1
*
Address 2
City
*
State
*
- Select -
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
--
Armed Forces (Americas)
Armed Forces (Europe, Canada, Middle East, Africa)
Armed Forces (Pacific)
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
Virgin Islands
ZIP code
*
Enter your account information
Username
*
Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.
E-mail address
*
A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.
Password
*
Confirm password
*
Provide a password for the new account in both fields.