Pick-Me-Up Data Card Form
If you have completed a clean-up as part of the Great Nova Scotia Pick-Me-Up program, please fill out this form below to submit your data electronically. Thank you for your participation.
Coordinator contact information
Coordinator's first name *
Your answer
Coordinator's last name *
Your answer
Phone number *
Your answer
Email address *
Your answer
Clean-up information
Team name
Your answer
Date of clean-up *
MM
/
DD
/
YYYY
Location of clean-up *
Your answer
Municipality *
Your answer
Number of participants *
Your answer
Duration of clean-up *
Number of hours
Your answer
Which type of clean-up did you do? *
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