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3. ------2023 CITY WIDE CLEAN UP WEEK------
6. FAIRBURY: APRIL 24-26, 2023
7. JANSEN: APRIL 28, 2023
10. -----REGISTRATION FORM-----
12. NOTE:

    Individual Clean-up days should be scheduled no later than 1 week prior to Clean-up week for both Fairbury and Jansen. Fairbury Clean-Up days will be April 24, 25 & 26, 2023. Jansen Clean-Up Day will be Friday, April 28, 2023. Scheduling can be done online via submission of this form or by calling the Fairbury Transfer Station directly at 402.729.4078.

14. CONTACT INFORMATION
16. Name*
17. Phone Number*
18. Email Address
22. ADDRESS INFORMATION
24. House Number (i.e. 101)*
25. Prefix (check if applicable)

    1. North
    2. South
    3. East
    4. West
26. Street (i.e., A, B, Oak, 1st)*
27. Suffix*

    1. Avenue
    2. Boulevard
    3. Circle
    4. Drive
    5. Street
30. Apartment # (if applicable)
34. CHECK ALL ITEMS THAT APPLY

    (If not listed, add items into the next field)

    1. Appliances (Stove, Fridge, Washer/Dryer)
    2. Cabinets
    3. Car
    4. Car Parts (NO TIRES)
    5. Carpet

    1. Exercise Equipment
    2. Furniture
    3. Large TV
    4. Piano
    5. Water Heater
35. LIST ITEMS TO BE PICKED UP
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field