Form Center

2. By filling out this form you are taking a pledge to become a PURE Citizen. A PURE Citizen does their best to eliminate single use plastics in their everyday life. Together each one of us can make Jupiter a better place. Thank you for taking the pledge.
4. First Name
5. Last Name
7. Email Address*
9. Florida has a very broad public records law. Under Florida law, e-mail addresses are public records. The Town makes every effort to protect individual privacy, but may be compelled to provide email addresses in some circumstances under Florida law. If you do not wish to provide your email when signing up for this program, please call Bethany Thomas at (561) 741-2347.
Leave This Blank:


11. 1. Receive an email copy of this form.
12. Email address

    This field is not part of the form submission.

13. Submit

* indicates a required field