___
YES! I want to renew!
Name(s):
Camp Road:
Summer Address:
Winter Address:
Phone (summer):
Phone (winter):
Email:
Email will
be used to provide timely information about activities & concerns
of our association. If at any time you would like to discontinue
this service, you may respond to the email asking us to remove
your email address. |
___
I’m a brand-new member!
Amount enclosed:
___ $15 Individual
membership
___ $25 Family
membership
___ $50 Lake
Benefactor
___ $100
Lake Patron
___ $250
Lake Steward
Special Donation:
Date: ___/___
/_____
Please make
check payable to: SP/MLA, P.O. BOX 532, OAKLAND, ME 04963
Credit Card
Authorization:
Credit Card
Type: (Circle One)
MC
| Visa | Amex | Discover
Credit
Card Number:
Expiration
Date: _____/_____
Your Signature:
|
