PROVINCE LAKE ASSOCIATION
P.O. BOX 24
EFFINGHAM, NH 03882-0024

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_____

   Lake level____         Lake Host___ Watershed Plan Volunteer____

   Membership committee____         

   Serve as officer/board member___

THANK YOU FOR YOUR SUPPORT