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Halifax River Cleanup

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Halifax/Indian River clean up registration form

Group/family name:  
Group contact information
First name:  
Last name:  
Address: (for future notices)  
City:  
Zip:  
Telephone number:  
Fax number:
E-mail address:  
Number in your group:

T-shirt sizes
Type in total number for each size below

Adult
Small
Adult
Medium
Adult
Large
Adult
X-Large
Adult
XX-Large
Child
Large

Location
Where do you want to volunteer?

Lunch
Will you be attending lunch at one of the following locations?

Special needs
Do you have any special accessibility requirements?

If there are more than 20 individuals in your group, Would you like to pick up your supplies in advance?
The participants will be contacted as to pick up locations.  Supplies will be available April 18 - 20 from 10:00 a.m. to 5 p.m. 

Yes No

 

 

Comments or questions?
E-mail the


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