Purple Loosestrife sighting - Mail-in report form

PURPLE LOOSESTRIFE
Mail-in Report Form

Directions: Use the PRINT command in your browser to print out this form. Complete as much of the information as possible then mail the form to the address below. Your assistance in expanding our loosestrife sighting database is greatly appreciated.

This form is also available in an On-line version, which you can SUBMIT to the LRCA.

Mail the completed form to:
Loosestrife Report
Lakehead Region Conservation Authority
P.O. Box 10427
Thunder Bay, ON P7B 6T8

Yes, I have seen Purple Loosestrife growing in the following location:

Location:

Township/City: _________________________________________________

Nearest Intersection
or Address: _________________________________________________

_________________________________________________

Describe how to
find the site: _________________________________________________

_________________________________________________

_________________________________________________

_________________________________________________

_________________________________________________

e.g., 300 metres east of bridge in south roadside ditch; just before start of guard rail

Map Reference
(if any) _________________________________________________

_________________________________________________

_________________________________________________

e.g., Topographic map 52 A/15 'Kakabeka Falls'
Grid reference 077 (east) 653 (north) 89`36'0"W 48`24'50"N

If you have photos or a sketch map that you could attach or copy on the back of this page, please send them along as well.

Type of Area (check one)

___ Marsh or Wetland   ___ Stream or River   ___ Pond or Lake shoreline

___ Ditch   ___ Roadside   ___ Meadow, Pasture or Field

___ Other (please specify)  ________________________________________

Number of Plants (check one)
___ Less than 20 ___ 20-99 ___ 100-1,000 ___ More than 1,000

Reported by:

Name: ________________________________________________

Address: ________________________________________________

________________________________________________

City: ___________________ Prov.: ____ Postal Code: ________

Phone: (optional) ________________________________________________

E-mail: (optional) ________________________________________________

~ Together we can control the spread of purple loosestrife ~

Use the PRINT command in your browser to print out this information.

Back to Purple Loosestrife page Go to On-line Purple Loosestrife form

Lakehead Region Conservation Authority
P.O. Box 10427; 130 Conservation Rd.
Thunder Bay, ON P7B 6T8 (Canada)
Telephone:(807) 344-5857 Fax:(807) 345-9156

Location:
Township/City:	_________________________________________________

Nearest Intersection or Address:	_________________________________________________
	_________________________________________________

Describe how to find the site:	_________________________________________________
	_________________________________________________
	_________________________________________________
	_________________________________________________
	_________________________________________________
	e.g., 300 metres east of bridge in south roadside ditch; just before start of guard rail

Map Reference (if any)	_________________________________________________
	_________________________________________________
	_________________________________________________
	e.g., Topographic map 52 A/15 'Kakabeka Falls' Grid reference 077 (east) 653 (north) 89`36'0"W 48`24'50"N
If you have photos or a sketch map that you could attach or copy on the back of this page, please send them along as well.

___	Marsh or Wetland	___	Stream or River	___	Pond or Lake shoreline
___	Ditch	___	Roadside	___	Meadow, Pasture or Field
___	Other (please specify) ________________________________________

Reported by:
Name:	________________________________________________

Address:	________________________________________________
	________________________________________________

City:	___________________ Prov.: ____ Postal Code: ________

Phone: (optional)	________________________________________________

E-mail: (optional)	________________________________________________