Activity Report

Stream Team Identification

Team Number

Team Name:

*Activity Reporter's First Name:

*Activity Reporter's Last Name:

Business or School (if applicable):

Contact/Shipping Information

Please help us save on shipping costs; ship to your office or school if possible!

Is the shipping address commercial or residential?: Residential Commercial

*Shipping Address (no P.O. box please):

*City:

*State: (none) Alabama Alaska American Samoa Arizona Arkansas Armed Forces Africa Armed Forces Americas Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

*Zip Code:

*Home Phone:

Work Phone:

*Email:

*Preference: Home Phone Work Phone Email

Team Contact Person Information

*Contact Person for Team (First Name):

*Contact Person for Team (Last Name):

Is there a change in Contact Person?: No Yes

Is there a change in Contact Person's address?: No Yes

Stream Team Activity

*Type of Activity: (none) AAA - Adopt-An-Access (completed agreement) ADV - Advocacy (other not already listed) AGE - Agency event ART - Article written ASC - Association activity AWA - Award received DIS - Display at fair, mall, school, etc. EDU - Educational project FIS - Fish stocking (MDC coordinated stocking event) FOR - Forestkeepers GPS - GPS Reading GRE - Greenway project GRT - Grant (applied/received) HAI - Habitat Improvement (not streambank stabilization) INV - Inventory Guide completed ISM - Invasive Species Monitoring LET - Letter written in support of ST issue LPU - Litter Pickup MED - Media Contact MEN - Mentoring or Recruitment MRP - Monofilament Recovery & Recycling Project MTG - Meeting (held/attended) NPS - Rain garden, rain barrel, green roof installation/maintenance OTH - Other (describe) PLN - Planning events (includes scouting streams for cleanups) PLT - Planted Trees PPM - Photo Point Monitoring PRE - Presentation to groups, gov't, etc. REC - Recruited new member/Team RIW - Riverwatch/River observation SAM - Stream Access Maintenance SDS - Storm Drain Stenciling SSP - Streambank Stabilization Project WAT - Watershed Mapping WKS - Workshop (held/attended) WQM - Water Quality Monitoring

If the activity was not in the list above, please describe it here:

*Activity Date:

*Stream Name:

Activity County: (none) Adair Andrew Atchison Audrain Barry Barton Bates Benton Bollinger Boone Buchanan Butler Caldwell Callaway Camden Cape Girardeau Carroll Carter Cass Cedar Chariton Christian Clark Clay Clinton Cole Cooper Crawford Dade Dallas Daviess DeKalb Dent Douglas Dunklin Franklin Gasconade Gentry Greene Grundy Harrison Henry Hickory Holt Howard Howell Iron Jackson Jasper Jefferson Johnson Knox Laclede Lafayette Lawrence Lewis Lincoln Linn Livingston Macon Madison Maries Marion McDonald Mercer Miller Mississippi Moniteau Monroe Montgomery Morgan New Madrid Newton Nodaway Not designated Oregon Osage Out of State East Out of State NW Out of State South Ozark Pemiscot Perry Pettis Phelps Pike Platte Polk Pulaski Putnam Ralls Randolph Ray Reynolds Ripley Saint Charles Saint Clair Saint Francois Saint Louis Sainte Genevieve Saline Schuyler Scotland Scott Shannon Shelby Stoddard Stone Sullivan Taney Texas Vernon Warren Washington Wayne Webster Worth Wright

Activity Basin: (none) Not Designated Big River Black River Blackwater River Bourbeuse River Chariton River Cuivre River Current River Eleven Point River Elk River Fabius River Fox River Gasconade River Grand River Headwater Diversion Jacks Fork River James River Lamine River Meramec River Missouri River Moreau River Niangua River Nodaway River North River N Fork White River Osage River, West Big Piney River Platte River Pomme de Terre Sac River St. Francis River Salt River South Grand River Spring River Thompson River Mississippi River, Upper White River Wyaconda River Osage River, East Mississippi River, Lower Locust Creek

Miles of river covered (if applicable):

*Number of volunteers involved:

*Project hours:

Total hours spent on project (Number of Volunteers x Project Hours):

Thank You Items (Optional)

You may request these free items in any combination. Shipment is subject to availability. Please allow up to three weeks for delivery.

Item	Number Requested
*Teams will only receive the number of supplies for volunteers reported above.* T-Shirts (Stream Team) (shipped in available sizes and colors)	YS YL S M L XL XXL XXXL
COLORING BOOK (Aquatic Invertebrate)
Keychains (Whistle - Stream Team)
Koozies (Stream Team)
Pencils (Get Into Missouri Streams)
Pop It Fidget Toy
Stickers (I Love Missouri Streams, 3" round)
Tattoo	ST Logo
Vinyl Decal	Go With the Flow I Live For Clean Streams

Activity Prize Drawing (Optional)

If you would like to be included in our 'Activity Prize Drawing', select 'Yes' below and enter all the participants' names in the box provided. The more activities you submit, the better your chances! New prizes will be drawn every three months.

If you are a teacher or youth group leader and wish to be included in our drawing, select 'Yes' to be entered in the 'Youth Group Prize Drawing'. You do not need to enter the participants' names in the box.

Would you like to be included in our 'Activity Prize Drawing'?: No Yes
Participants' Names:
-- OR --
Would you like to be included in our 'Youth Group Prize Drawing'? (teachers/youth group leaders only): No Yes

Activity Supplies (Optional)

Item	Number Requested
First Aid Kit (Limit one per 10-15 participants)
Litter Pickup Bag (24" x 36" green mesh) for cleanups with larger trash items
Litter Pickup Bag (Standard red mesh)
Work Gloves	A. Small B. Medium C. Large D. XL

Activity Photos (Maximum of 5 photos up to 5MB each)