Great American Cleanup-Online Adult Group Registration

REGISTRATION FORM
Great American Cleanup
March 10, 2012

DEADLINE FOR EARLY REGISTRATION
February 6, 2012

SUPPLY PICKUP
Tuesday and Wednesday
March 6th and 7th

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
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 drop off
of bags
Additional Comments