ALPALS - Alabama People Against a Littered State

Apply to Adopt-a-Mile for Alabama County Roads

Tell us about your Organization

*Organization Name:

*Type of Organization:

*County:

*Organization Address:

*City:

*State:

*Postal Code:

*Phone #:

Contact Person Information

*First Name:

*Last Name:

*Address:

*City:

*State:

*Postal Code:

*Email:

*Phone #:

County Road Section(s) you propose to adopt

*County Road #:

From Mile Post:

To Mile Post:

If the county road has mile markers (many don't), you can enter in the start mile marker and the end mile marker of the road section you'ld like to adopt. If no markers exist, use the Description box to define the starting and ending point.

Description of Section:

If the county road doesn't have any mile markers, use this text box to provide a description that defines the starting and ending points of the section of road you would like to adopt.

*County Road #:

From Mile Post:

To Mile Post:

Description of Section:

If the county road doesn't have any mile markers, use this text box to provide a description that defines the starting and ending points of the section of road you would like to adopt.

I Authorize the use of the typed name below as an electronic signature.

Leave this checkbox unchecked if you would like to print this form and fax or mail it. If you check this box, please type in your name below. Your form will be submitted automatically to Alabama PALS.

Electronic Signature: