P.O.
2012 Membership Application

Please fill out and mail with $25.00 dues to above address.
Name(s):
________________________________________________________________________
Lake address:
__________________________________________________________________
Summer telephone:
( )
______- ___________
Primary address:
__________________________________________________________________
________________________________________________________________________________
Primary telephone:
( ) ______-____________
E-Mail Address: ______________________________
Send my newsletters via email?
Yes____ No____
(Please consider as this helps reduce our postage
costs.)
Preferred mailing address:
Summer (
) Primary ( )
Additional
Contribution for weed control /Watershed plan match $________
(If possible, this is greatly
needed please
add to dues and Thank you very much )
I would volunteer to help with:
Fund-raising:: Yard sale___ Raffle___ Golf tourney___ Logo item sales___
Other: Water testing____ Weed
watching___ Boat Parade_____
Membership committee____
Serve as officer/board member___
THANK YOU FOR YOUR SUPPORT