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2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Email:
14. Phone:
16. I/We pledge to protect our streams and Lake Superior by:
18. I/We pledge to use less water by:
20. Select:

    1. Individual
    2. Group
22. Name of Group:
24. I/We pledge to make:

    1. 1 week = 7 ice orbs
    2. 2 weeks = 14 ice orbs
    3. 1 month = 30 ice orbs
    4. Other amount
26. If you chose "other amount," please list below how many ice orbs you will make:
28. Balloon & Ice Orb Delivery Or Pick-up (choose option):

    1. I will pick up balloons from the Environmental Services Division (51 E 1st St, Superior, WI)
    2. Please deliver balloons to address listed above.
    3. I will deliver ice orbs to Barker’s Island on the last Thursday in January.
    4. Please pick up from address listed above. **Ice orbs must be frozen and ready by the last Thursday in January.
30. If pick-up location is different than address above, please list:
32. Pick-up date & time:
34. Questions?
    Contact Megan for any questions at (715) 394-0392 or hogfeldtm@ci.superior.wi.us
Leave This Blank:


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

    This field is not part of the form submission.

38. Submit

* indicates a required field