Connecticut River Watershed Council: Source to Sea Cleanup Registration

Please complete this form before September 1, 2008, so that we can link individuals with groups and do our best to coordinate the cleanup.

Thanks!

Required fields are indicated with an asterisk (*).

Your Group's Contact Information

Contact Name*

Group Name (if applicable)

Address*

City*		State*		Zip*

Phone*

Email*

Your Group's Cleanup Information

Name of river/tributary where you will hold cleanup:*

Town name and area where you'll be working:*

Estimated number of volunteers *

Cleanup date *

Start time		Approximate end time

Other Information

Are you interested in receiving Cleanup supplies from us -- trash bags, gloves, bandaids? *

Yes No

If yes, what supplies would be most useful to you?

Would you like a free t-shirt for the group leader(s)? List number of group leaders on your cleanup team (typically 1-2 people), and t-shirt sizes below.*

Yes (fill in sizes below) No thanks, I don't want a group leader t-shirt.

SIZE (sm, med, lg, xlg) and # of shirts

Would you like to order event t-shirts for volunteers at cost ($10 per shirt)? please list numbers of t-shirts to order and sizes (sm, med, lg, xlg) below.

Yes (fill in sizes below) No thanks, I don't want to order volunteer t-shirts.

SIZE (sm, med, lg, xlg) and # of shirts

We would like to make it easy for interested volunteers to link up with existing groups this year. Can we post your name and email and/or phone number on our web page list of cleanup groups prior to the Cleanup?*

Yes No

Are you interested in attending a pre-cleanup meeting in your state to pick up supplies, go over any questions, and for folks to meet each other*

Yes No

If yes, what days of the week and times (evenings, etc.) would be most convenient for you?

Would you be interested in making a donation to help offset our costs for organizing the cleanup?

Yes No, thanks
(If yes, we will include a donation envelope when we mail you your cleanup materials.)

Have you participated in the Source to Sea Cleanup before?

Yes No

Do you have any other comments or questions?

Any Pictures?
Please email any pictures you take to cleanup@ctriver.org

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