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Clean-up Kit Identifier

Kit Number:*

This is a 5-digit number marked on the outside of your bulk bag.

Participant Name*

First Name

Last Name

Setnet Site Name

This is a 5-digit number marked on the outside of your bulk bag.

Email*

Phone*

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Please fill out your contact information below.

Clean-up Location*

Please include lat/long if known.