Dpa2009-duesform

DPA Inc. 746 Montauk Hwy, Bayport, NY 11705 THIS IS THE 2009 DPA DUES FORM COVERING DUES AND PROGRAMS ORGANIZED BY THE DPA. THE DPA DIRECTORS WORK HARD FOR OUR COMMUNITY AND WE ASK YOU TO PLEASE PAY YOUR 2009 DUES. Homeowner Name(s): Mainland Address: All Beach Addresses: Emergency Tel:

Beach Tel:

E-mail:

TOTALS

1.) DPA MEMBERSHIP DUES NOTICE 2009 □ Membership dues for the calendar year 2009 will be $50/membership □ Membership covers single/joint ownership for one or more houses in same name □ Please help the DPA and its hardworking volunteers with its many tasks for the community.

$50/membership (1 or more properties): 2.) FIRE ISLAND ASSOCIATION (FIA) FUND RAISER Please consider a gift of $3/month for each month that you visit Fire Island:

3.) DAMMINIX 2009 - DAVIS PARK & OCEAN RIDGE - BY FRIDAY, MARCH 27, 2009 The cost this year for two applications is $54/lot in Davis Park and $64/per lot in Ocean Ridge There is a 15% discount for multiple lot ownership.

Lot to be treated: Davis Park $54

Ocean Ridge $64

#1 #2 #3 #4

Totals: Less 15% for more than 1 lot: Total for Damminix:

Total for Damminix:

I elect not to participate in The Damminix Program, but am treating the following properties via alternate method (s): _____________________________________________________ #1 ________________

#2 ________________

#3 ________________

N/A

#4 ________________

4.) DAVIS PARK BEAUTIFICATION DONATION Please help our voluteers beautify Davis Park ... Total:

5.) 4TH OF JULY PARADE DONATION: Total:

6.) RECYCLE GARBAGE CANS $15/EACH DELIVERED

# OF CANS: ____ Total:

7.) MISCELLANEOUS DONATION TO THE DPA

Total:

GRAND TOTAL: TOTAL AMOUNT OF CHECK (made payable to "Davis Park Association Inc ." or "DPA Inc ."):

Please Mail Check to: DPA Inc. 746 Montauk Highway, Bayport, NY 11705