CLIA Table and Chair Rental Form

Cossayuna Lake Improvement Association

Table and Chair Rental Form
CLIA tables and chairs are available for rental to CLIA members during the summer season. Contact Bob Reilly at 631.897.4811 or dakotabr@optonline.net to check for availability BEFORE you submit your payment.
RENTAL HOURS: 8:00 AM – 3:00 PM the next day

CLIA Member Rental Fees:

1 table and 10 chairs - $20

1 table (no chairs) - $10

10 chairs (no table) - $10

Security Deposit - $50

MEMBERSHIP DUES (required if not already paid) * $ 80
Regulations and Guidelines:

· Rentals are available to CLIA members in good standing (dues are current)

· Tables and chairs are to be returned clean and in good repair

· Security deposit will be returned within 2 weeks after inspection of the premises

Cancellation Policy: Rental Fee and Security Deposit will be returned up to 1 day before the reservation.

By submitting this form, I agree to the terms of the CLIA Rental Agreement and will be responsible for the regulations and guidelines as stated above.
Name*

First NameLast Name
Mailing Address (for deposit return) *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number*
Email Address*
example@example.com
Event Date*

MonthDayYear
Return by 3 pm the following day
Comments / Notes
Please select the number of tables you wish to rent

012345
Please select the number of chairs you wish to rent

01020304050
Please select*

Security Deposit
Is your membership current? ($80 membership fee applies if not current)*

YesNo
Total Table & Chair Rental Fee
Amount Due

prevnext( X )
USDCLIA Table and Chair Rental
Click on the "Submit" button to pay for your rental. You will be sent to a processing page, where you can enter your Credit or Debit card information or log in to your PayPal account.
Questions can be directed to:

Bob Reilly 631.897.4811 or dakotabr@optonline.net
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.
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Cossayuna Lake Improvement Association