CLIA Lake Harvesting Donation Form

Cossayuna Lake Improvement Association

Harvesting Donation Form
Make a donation to help fund the harvesting of invasive and non-native weeds and improve water quality of our lake! Note: This donation will be used to help fund the overall program and will not be used to provide harvesting services to a particular property.
Name*

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number

Area CodePhone Number
Email Address*
example@example.com
I would like to make a donation for Lake Harvesting (to combat invasive and non-native weed species) in the following amount:*
prevnext( X )
DONATION - HARVESTING$25

DONATION - HARVESTING$50

DONATION - HARVESTING$100

DONATION - HARVESTING$250

DONATION - HARVESTING$500

DONATION - HARVESTING$1,000

Total $0.00
Comments / Notes
If you are paying by Credit or Debit card, do NOT click on the option to save your card information - selecting that option will take you to the PayPal login screen.
Questions can be directed to the following individuals:

Membership: Bob Reilly 631.897.4811 or dakotabr@optonline.net

Harvesting: Tim Hopkins 518.466.8653 or thop920@gmail.com

Lake Management: Sheila Rappazzo 518.429.8312 or sarappazzo@yahoo.com
CLIA is a 501(c)3 nonprofit organization. Donations are tax exempt to the extent of the law. A copy of our most recently filed financial report is available from the Charities Registry on the New York State Attorney General's website (www.charitiesnyc.com) or, upon request, by contacting the New York State Attorney General, Charities Bureau, 28 Liberty Street, New York, NY 10005 or us at POB 81, Cossayuna, NY 12823-0081. You may also contact the New York State Office of the Attorney General at 212.416.8401.
Should be Empty:

Cossayuna Lake Improvement Association