Great American Cleanup-Online Youth 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
Location of Cleanup and
Additional Comments
Adults Registering
Students Registering