ADULT GROUP    REGISTRATION FORM GREAT AMERICAN CLEANUP March 10, 2012 DEADLINE FOR REGISTRATION Monday, February 6, 2012 Supply pick up March 6th and 7th at Mini-Transfer Station 19675 Kenilworth Blvd. in Pt. Charlotte Mail or Fax or e-mail registration form to: Keep Charlotte Beautiful, Inc. Great American 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 GROUP INFORMATION Group Name _____________________________________________________ Contact Name____________________________________________________ Address_________________________________________________________ Phone___________________________________________________________ E-Mail__________________________________________________________ Location of trash bags_______________________________________________ T-SHIRT INFORMATION Please indicate the number of T-shirts needed for each group member participating ______Small ______Medium ______Large ______Extra Large