COASTAL CLEANUP DAY 2018 - PATCH ORDER FORM
Thank you for helping us make our annual Coastal Cleanup Day event a huge success! To say "Thanks" we have a nifty patch for our volunteer scouts and guides!

Please complete the following form to request your scout patches. Forms will be accepted through October 5. ILACSD will notify you once they are ready for pickup or to be mailed out in early October. Thank you!

2018 Coastal Cleanup Day Patch
Name *
Your answer
Email address *
Your answer
Phone number *
Your answer
Address *
Your answer
City *
Your answer
Zip code *
Your answer
Cleanup site *
Your answer
Troop number/Tribe name *
Your answer
How many patches do you need? *
Your answer
How would you like to receive your patches? *
If you select the mailing option, ILACSD requests a small but helpful $2-3 donation to help cover shipping costs. Thank you for supporting our mission!
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