Harmful Algal Blooms Educational Materials Request Form

2. Name*
3. Email Address*
5. Mailing Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Fax Number
13. Business/Organization
15. Please check one*

    1. I own a lakefront property on Cayuga, Owasco, and/or Skaneateles lake(s) in Cayuga County
    2. I own multiple lakefront properties on Cayuga, Owasco, and/or Skaneateles lake(s) in Cayuga County
    3. I no longer own a lakefront property on Cayuga, Owasco, and/or Skaneateles lake(s) in Cayuga County
    4. I am part of a local business/organization
    5. Other
17. Please check one

    1. My lakefront property draws water from the lake for household use
    2. My lakefront property uses a well for household use
    3. My lakefront property uses public water for household use
19. Lakefront Property/Business/Organization Address*
21. Additional lakefront property addresses
23. Please check one*

    1. I would like to receive HABs educational materials for my lakefront property
    2. I would like to receive HABs educational materials for my local business/organization
    3. I do not wish to receive HABs educational materials at this time, but keep me informed
25. Please check one

    1. Send educational materials to my lakefront property address
    2. Send educational materials to my mailing address
27. Comments
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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