Apply to Adopt-a-Mile for State and U.S. Highways

Adopt-a-Mile — State or US Highway Application form

Organization Name(Required)

Type of Organization(Required)

County(Required)

Organization Address(Required)

City(Required)

State(Required)

Postal Code(Required)

Phone(Required)

Name(Required)

First Last

Address(Required)

City(Required)

State(Required)

Postal Code(Required)

Email(Required)

Phone(Required)

State or U.S. Highway #(Required)

From Mile Post(Required)

To Mile Post(Required)

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

For Program Sponsorship Information or to Ask About Planned Giving, please email [email protected]