2016 Signup Form for Site Captains-- International Coastal Cleanup in Virginia

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The 2016 Virginia Waterways Cleanup is part of the Ocean Conservancy's International Coastal Cleanup (ICC)! All ICC events in Virginia are coordinated by Clean Virginia Waterways of Longwood University.
Use this form to sign up YOUR group for the ICC.

ICC events in Virginia can be held on ANY date between late August and early November. Mostly, they are held in September and October. If you have several sites, you can register just once, then send an email to cleanva@longwood.edu with a list of all of your sites. Be sure to let us know if your sites are open to the public, or if they are "closed" for a private group.

Questions? Please call 434-395-2602 or send an email to cleanva@longwood.edu. Thank you for making our world cleaner!

Last Name *

First Name *

Name of organization (or school, park, business) *

Shipping Address, Line 1 (We ship via UPS, so no P.O. Box addresses.) *

Shipping Address, Line 2

City *

State *

Zip Code *

Cleanup Site Name *

County (or incorporated town) *

Date of Cleanup (if known)

YYYY

Start Time (if known)

Time

End Time (if known)

Time

Is your cleanup event open to all interested volunteers? *

Yes- This listing will appear on the CVW website where volunteers may find your contact information to signup to help at your event or call with questions.

No- It is for a private group. (CVW will not list your cleanup information on its website.)

Required

Contact Email for CVW to use to contact you. *

Your phone number for CVW to contact you. (Optional) *

If your cleanup is open to the public, which phone number and which email address should CVW post on its website?

Phone number:

Email address :

Provide special instructions about your cleanup.

This paragraph will be placed on CVW's web page so volunteers can learn about your cleanup event. Include: where to meet, what to bring, your website address, other details, etc. *

Number of volunteers estimated at your Cleanup Site. If unknown, please type "will let you know later." *

Which best describes your cleanup site? *

Inland

Coastal

Watercraft/Boat/Canoe

Underwater

Required

NEW: Clean Swell (app for smart phones)

Clean Virginia Waterways is excited about this NEW way to enter data from cleanup events! Please download this FREE app and try it out. CVW is encouraging our Site Captains to use the Clean Swell app this fall for all or part of your cleanup data.

Will you use the new Clean Swell app to collect ICC data this fall? *

YES, we will use it this fall to collect data

NO, we will not use it this fall

Other (If you chose "other," please use the line below to tell us about your data-collection plans.)

Other:

Required

On the next page, you will enter your supply needs.

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