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REGISTRATION FORM
COASTAL CLEANUP
September 17, 2011
DEADLINE FOR REGISTRATION
September 6, 2011
4:00pm-7:00pm
SUPPLY PICKUP
September 13, 2011
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)
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Port Charlotte Beach Complex
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Eldred's Marina, Placida
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Group Information
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Group Name
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Contact Name
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Address
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Phone
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E-Mail
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T-SHIRT INFORMATION
We are asking groups to only order shirts for those that did not
participate in the Great American Cleanup, as the logo will be the same
for our 10th anniversary.
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Small
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Medium
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Large
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Extra Large
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Thank You Gift
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Location of Cleanup and
Additional Comments
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