2006—TEAM REGISTRATION FORM

 (PLEASE PRINT CLEARLY)
PLEASE COMPLETE FORM AND RETURN TO THE
OFFICE OF THE BRONX BOROUGH PRESIDENT
(ATTN: Team Up to Clean Up the Bronx)

By Fax: 718-537-3583   By Mail: 851 Grand Concourse, Bronx, NY  10451

By E-mail: teamuptocleanup@bronxbp.nyc.gov

Clean-Up Activity Information:

Date:___________     Start Time:_________   End Time: ___________   CB#: ___________

Clean-Up Location (with Cross Streets): ______________________________________________

 # of Volunteers Anticipated:   Adults: _______            Youth (under 18): _______

     YES!   We would like to accept (#)_______ referred volunteers at our site.
(There is no guarantee that people will register for your site, but information will be made available to interested parties.)

Brief Description of Project: 

_____________________________________________________________________________

Organizational/Contact Information:

Organization’s Name: __________________________________________________________

Organization’s Address: ________________________________________________________

Key Contact’s Name & Phone #: _________________________________________________

Site Captain (s) Name & Phone #’s (Business, Home, Cell): __________________________

______________________________________________________________________________

Site Captain’s E-mail: ___________________________________________________________