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淨海灘報名表單
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* Indicates required question
參與單位名稱
*
Your answer
淨灘日期
*
MM
/
DD
/
YYYY
淨灘地點（ＧＰＳ 定位點）
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Your answer
淨灘的所屬單位
*
Your answer
是否需要垃圾清運（需提前20天公文申請）
*
是
否
預計參與人數
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Your answer
是否願意開放給民眾參與
*
是
否
活動聯絡人名字
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Your answer
聯絡電話
*
Your answer
Ｅ-mail
*
Your answer
活動訊息來源
*
ＬＤＩ官網/ 臉書/ ＩＧ
媒體/ 報紙/ 電台
曾參與過ＬＤＩ辦理的活動
學校
親友
Other:
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