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

2011 Membership Application

Please fill out and mail with $25.00 dues to above address.

Name(s): ________________________________________________________________________

Summer address: __________________________________________________________________

 

Summer telephone: (       ) ______- ___________ 
                         
Winter address:   __________________________________________________________________

________________________________________________________________________________

 

 Winter telephone: (       ) ______-____________
                          
 E-Mail Address: ______________________________

Send my newsletters via email?

  Yes____     No____

(Please consider as this helps reduce our postage costs.)

Preferred mailing address:

Summer (    )       Winter (    )

Contribution for weed control $________
  (please add to dues)

I would volunteer to help with:

Fund-raising:

  Yard sale___ Raffle___ Golf tourney___

  Logo item sales___        

Other:

   Water testing____    Weed watching___

   Lake level____          Boat parade___

   Membership committee____         

   Serve as officer/board member___

THANK YOU FOR YOUR SUPPORT