RELI: Membership/Donation Form

Membership Form

Name:
Address:
City: State: ZIP:
Phone:
Email:

Level of Support
Benefactor	$1000
Patron	$500
Supporting Member	$250
Friend	$100
Member	$35
Other	$

Yes, I want to volunteer! Please contact me.

Mail your completed form, along with a check, to:

Renewable Energy Long Island
62 Newtown Lane, Suite 103
East Hampton, NY 11937
631-329-8888

To contribute via credit card, please use our online form through PayPal.

RELI is a 501(c)3 non-profit organization. All contributes are tax deductible to the fullest extent of the law.

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