Register to Organize and Lead a Coastal Cleanup

Please complete and submit the form below (if you only want to particpate in a cleanup, use the participant form):

This form is secured to safeguard your personal information.

Coastal Cleanup Registration
name:
organization:
email:
mailing address:
town:
state
zip code:
home phone:
work phone:
cleanup location (beach/shore area and town name):
date:	September
time:
number of children's certificates required:
total number of participants:
open to general public?	yes no
	please send me a copy of this year's coastweek poster

return to the Cleanup page

September 12-19, 2009