REGISTRATION FORM GREAT AMERICAN CLEANUP March 10, 2012 DEADLINE FOR REGISTRATION Monday, February 6, 2012 Pick up supplies on March 6th and 7th at Mini-Transfer Station 19675 Kenilworth Blvd. in Pt. Charlotte Mail, 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:_________________________________________ Please indicate the # of people participating: Students:___________________ Adults:______________________ Groups registered by the deadline will receive a gift. All groups will receive trash bags even those who have registered late. We will make every attempt to supply all students with a gift