Join W.A.K.E U.P. -Application

W.A.K.E. U.P.

Volunteer Registration Form

Title:________

First Name:____________________________

Last Name:___________________________________

Organization Name:______________________________

EMAIL:_________________________________

Home Phone or Cell Number:______________________

Street Adress:_____________________________

City:______________________ State:_____________

Zip:__________

Type of Vessel:____________________________

Size of Vessel:_____________________________

Waterway to be Adopted:____________________

Please mail registration form in a stamped envelope and mail to:

Department of Environmental Resources
Town of Oyster Bay
150 Miller Place
Syosset, NY 11791

Thank you for Volunteering
It's time to W.A.K.E. U.P.!

W.A.K.E. U.P.

WATERWAYS ADOPTED KEEP ENVIRONMENTS UNDAMAGED & PROTECTED