international coastal cleanup day jamaica 2016 registration form

INTERNATIONAL COASTAL CLEANUP DAY JAMAICA 2016
REGISTRATION FORM
Please complete all fields to register your International Coastal Cleanup Day site(s). There are two deadlines
for registration: Friday, July 29, 2016 and Friday, August 12, 2016. Cleanup sites are registered on a first
come basis.
NAME OF COORDINATING
GROUP/ORGANIZATION
ADDRESS
PARISH
PHONE
EMAIL
NAME OF CONTACT PERSON 1
CONTACT PERSON 1 POSITION IN
COORDINATING ORGANIZATION
CONTACT PERSON 1 CELL #
CONTACT PERSON 1 EMAIL
NAME OF CONTACT PERSON 2
CONTACT PERSON 2 POSITION IN
COORDINATING ORGANIZATION
CONTACT PERSON 2 CELL #
CONTACT PERSON 2 EMAIL
FIRST TIME PARTICIPANT? (Y/N)
LOCATION OF THE SITE(S) YOU PLAN TO CLEANUP
NAME OF SITE
PARISH
UNDERWATER OR ON
LAND?
1.
2.
3.
4.
By signing this form, we agree to return all data collected at our International Coastal Cleanup event in
the form of completed coordinator and volunteer data cards before the deadline of Friday, September
30, 2016. We understand that failure to do so will result in our group being required to return IN FULL
any stipend received from the Jamaica Environment Trust, and us potentially being barred from
participating as coordinators in any future staging of the International Coastal Cleanup Day project
coordinated by the Jamaica Environment Trust.
_____________________________________________
Name (please print) of group representative
_________________________________________
Signature
__________________________
Date
Please return all completed registration forms to the Jamaica Environment Trust:
123 Constant Spring Road, Unit # 5, Kingston 8; Telephone: 960-3693; Fax: 926-0212;
Scan and email: [email protected]