CLIA Lake Management Donation Form

Cossayuna Lake Improvement Association

Lake Management Donation Form
Make a donation to fight invasive and non-native weeds and improve water quality of our lake!
Name*

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number
Email Address*
example@example.com
I would like to make a donation for Lake Management Projects (to combat invasive and non-native weed species) in the following amount:*
prevnext( X )
DONATION - LAKE MANAGEMENT$25

DONATION - LAKE MANAGEMENT$50

DONATION - LAKE MANAGEMENT$75

DONATION - LAKE MANAGEMENT$100

DONATION - LAKE MANAGEMENT$150

DONATION - LAKE MANAGEMENT$200

DONATION - LAKE MANAGEMENT$250

DONATION - LAKE MANAGEMENT$300

DONATION - LAKE MANAGEMENT$350

DONATION - LAKE MANAGEMENT$400

DONATION - LAKE MANAGEMENT$450

DONATION - LAKE MANAGEMENT$500

DONATION - LAKE MANAGEMENT$600

DONATION - LAKE MANAGEMENT$700

DONATION - LAKE MANAGEMENT$800

DONATION - LAKE MANAGEMENT$900

DONATION - LAKE MANAGEMENT$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 dakotabr1960@gmail.com

Harvesting: Tom LeCours, Harvesting Chair 518.366.1151 or tunamantom@yahoo.com / Gene Henry, Head Harvester 518.744.4768 or newpilotg@roadrunner.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