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

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

Enclosed is a check payable to RELI.
Please charge my pament of $ to my: MasterCard   Visa   AMEX
Card Number
Expiration Date:
Signature:	(required)

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

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
877-619-5572 fax