THE GREAT CALIFORNIA CLEANUP! Registration Form

Type of Event:

Date of Event: (Approximate, if necessary)

Estimated # of Participants:

Estimated # of Bags Needed:

Please let us know if you would like to receive any of the following supplies*:

Posters & Banners

Flower Seeds

Gloves

Drop Cloths (for paint projects)

(*Please note: Supplies are limited on some items.)

Contact Name:

Title:

Organization Name:

Shipping Address:(no P.O. Box, please)

City

Zip Code:

Telephone:

Email Address:

Fax:

Website:

Post on Event Web Calendar?

Yes, please post

No, do not post