Registration Form Fall Waterway Clean Up 2008 Saturday, October 4th - 9:00a.m.  until noon
Please return this form ASAP  to: Clean Valley Council, P O Box 523, Roanoke, VA 24003 or fax 345-5422
Name of Group
Team Captain/ContactPerson
Street Address
Address (cont.)
City
State
Zip/Postal Code
Day Phone	Evening Phone
E-mail
Number of Volunteers 18 & Over
Number of Volunteers Under 18
Estimated Number of Bags Needed Gloves Needed
Clean Up Site Located in	Botetourt County  City of Roanoke Roanoke County  Salem  Vinton
Cell Phone at the Clean Up Site
Address of clean up site where filled bags will be left for pickup
We thank you for caring about your Valley! For CVC use only:
Date Confirmation Letter Sent
Date Supplies Picked upby
Number of Bags                                                      Number of Gloves