Sign me up for the following beach cleanup(s)!:

Wednesday, August 20: Cleanup at Jenness Beach, 6:00 PM

September: Coastal Cleanup Sign up

Saturday, October 18: Cleanup at Jenness Beach, 10:30 AM

How many people (total)?  

  Adults  Children (under 12)

How can we contact you in the unlikely event we reschedule?:

Name
Organization
Work Phone
Home Phone
E-mail
Where will you be coming from? (this is to track mileage for our grants)

Would you like to be on our e-mail list to be reminded of future cleanups?:

Yes No

Would you like to receive our  monthly e-newsletter?

Yes No

How did you hear about the beach cleanup(s)? (United Way, web search, flyer, etc.)