LWLA Membership Application Form

Please click this link if you would like to >Pay your Dues online or make a donation

This form is for your 2008 dues which are $10 per family and expire on December 31, 2008

Please consider an additional donation to help support LWLA programs

Thank-you for your support!!!

Please Print and complete all fields

 

Name:  ____________________________________________________________________________

 

Mailing Address:  ______________________________________________________________________

 

                                    ______________________________________________________________________

 

Email Address:     _______________________________________________________________________

 

Home Phone:      ____________________________________________________

 

Lake Address:       Fire/Street #:  ________   Road:  _____________________________   Lake:  __________________

 

                                    Lake Phone:   ________________

 

Do you own the above Property?   ___ Yes   ___ No         If no, what is your relationship?     ____________________

 

If this is a new registration, please indicate the name of the previous owner:   _______________________________

 

(If this property is co-owned or if you own multiple properties, please include information on a separate page)

 

I would like to help reduce the cost of newsletters by receiving my copy electronically    

I would like to “Adopt” my road and help to keep ownership data current                    

           I would like to help the association with other projects

           I would like my donation acknowledged on the web page and in the next newsletter (name only not amt)

Please mail completed form to:  Treasurer – Lamoka Waneta Lakes Association, PO BOX 55 Tyrone, NY 14887