Program Contact

Denise Crowell

Phone: 902-420-3474

Fax: 902-424-5334

Register Now

Registration is easy! Either complete the following online form, or call us at: 902-420-3474 or toll free at 1-888-380-5008.

A Safety Information Booklet – all coordinators must read this before you begin!

Data Card – fill this out when you are done and send it back to Clean Nova Scotia. If you prefer to fill out your data card online, please click here.

Fields with an asterisk (*) are REQUIRED to submit form

Organization, Group, or Business Name
Primary Contact*
Alternate Name: (if applicable)
Address
Street AddressCityProvincePostal Code
Telephone Numbers
Home Phone
Work Phone
Cell Phone
Fax Number
Email*
Telephone Numbers for Alternate Name if Applicable
Home Phone
Work Phone
Cell Phone
Project Details
We are participating in:
- Garbage Mapping (ongoing - http://www.letsdoitworld.org/mapthewaste)
- Let's do it!: World Cleanup 2012 (Clean Across Nova Scotia - June 8)
- Our own cleanup (Great Nova Scotia Pick Me Up - Date of your choosing)
Date of Pick-Me-Up*
Location of Pick-Me-Up*
Reason for Picking This Location
Number of Participants
How did you hear about our programs?
- Through friends
- Radio
- Print media
- Posters
Is this your first time participating in the Great Nova Scotia Pick-Me-Up?
- Yes
- No
If not, how many times have you participated in the past?
Donation