International Coastal Cleanup

REGISTRATION FORM
COASTAL CLEANUP
September 25, 2010

DEADLINE FOR REGISTRATION
September 7, 2010

SUPPLY PICKUP & INFORMATION MEETING
September 20, 2010
6:00 PM
Environmental Campus

Mail, Fax, or e-mail registration form to:
Keep Charlotte Beautiful, Inc.
Coastal Cleanup
25550 Harbor View Road, Suite 2
Port Charlotte, FL 33980
Phone : (941)764-4390
Fax : (941) 764-4399
E-mail: glenda.anderson@ charlottefl.com

DROP OFF SITES ( not confirmed)
Port Charlotte Beach Complex
Eldred's Marina, Placida
Group Information
Group Name
Contact Name
Address
Phone
E-Mail
T-SHIRT INFORMATION
Please indicate the number of T-shirts needed for each group member
participating
Small
Medium
Large
Extra Large
Location of Cleanup and
Additional Comments