MEMBERSHIP APPLICATION

NAME:_______________________________________________________

HOME ADDRESS: _____________________________________________

HOME CITY: __________________________________________________

HOME STATE: ________________________________________________

HOME ZIP: ___________________________________________________

HOME PHONE: _______________________________________________

LAKE ADDRESS: ______________________________________________

LAKE CITY:  ___ Fort Ann_______________________________________       

LAKE STATE: New York________________________________________

LAKE ZIP: 12827______________________________________________

LAKE PHONE: ________________________________________________

E-MAIL: _____________________________________________________

Please print out this application and send it to the above address with you yearly dues of $20.00 

PLEASE FILL IN ALL INFORMATION AS REQUIRED

THANK YOU FOR HELPING PRESERVE OUR BEAUTIFUL LAKE