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Member Application

Membership Application
print out the form and mail as indicated
 
Wabedo-Little Boy-Cooper-Rice Lakes Association
 
Name:_______________________________________________
            Last                     First                     Spouse

Lake:__________________

Lake address:_________________________________________
                    Street
_____________________________________________________
City State Zip

Lake phone #:_________________________________________

Permanent address:____________________________________
                            Street

____________________________________________________
City State Zip

Phone #:_____________________________________________

Date:__________________

Email:________________________

Dues

Regular Member $20

AIS

Prevention/

Treatment

Fund

$20
Contributing Member $40 $40
Sustaining Member $60 $60
Benefactor $100 $100
Associate(non-voting) $25 $_____
(circle amount for both Dues and AIS categories)
Send to:

WLBCR Lakes Assoc, P.O. Box 133, Longville, MN 56655

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