Logo-Tagline-Protect-Our-Oceans

Volunteer Registration Form: 2017 West Australian Beach Clean-up

Contact Details




Volunteer/Group/Organisation Name

This field is required.

Contact Person(*)

This field is required.

Address(*)

This field is required.

Phone(*)

This field is required.

Mobile

This field is required.

Email(*)

This field is required.


Participants

What is the maximum number of people that you expect to participate at your site?




Adults(*)

This field is required.

Children(*)

This field is required.


My Site Details

Please complete this section only if you have chosen to register your own site.




What stretch of coastline will you clean up on the day? Please be as specific as possible.

This field is required.

Does your group have insurance for activities?


This field is required.

If so, please provide details.

This field is required.

If we have individuals wishing to participate in the area you specified, would you like us to pass your contact details to them?


This field is required.

Clean-up kits will include clean-up bags and a sharps container along with required paperwork. We ask you to request volunteers bring their own gloves. We will include a couple of spare pairs for each clean-up kit for anyone that hasn’t got any.

What size clean-up kit do you need?





Invalid Input

If "Other", how many packs do you need?




We will also provide data sheets, information sheets and rubbish pick-up (locations to be advised).





Other




Do you have any other information or requests?

This field is required.


 




Acknowledgement(*)

This field is required.

Please enter the letters and numbers that you see.(*)
Please enter the letters and numbers that you see.
Refresh
Invalid Input