Keep the Memories Coming

Please print and complete this form and return it along with your check or money order made payable to:

Conneaut Lake Institute, Inc.
P.O. Box 111
Conneaut Lake, Pa. 16316

Name:    ________________________________________________________

Address:________________________________________________________

             _________________________________________________________

             _________________________________________________________

E-mail address:____________________________________________________

Check Number:____________________     Amount:_______________________

I wish to have my name published on a donor list:    Yes________       No________

The amount of your donation will remain confidential unless you advise us otherwise.

Memories for our bulletin board:

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On behalf of Conneaut Lake Park and Conneaut Lake Institute, thank you for your donation to support our community park.

The Lake's..........The Place