Association Membership Application - Save The Lakes

   Association Name:                           Type: Lakes & Ponds Fishing Enviromental Conservation Other     

                    Website:       # of members:

Primary Contact Information:

   First name:      Last name:     Position: Select one President Vice Pres. Treasurer Secretary Board Member Member Other

   Mailing Address:  Street: 

         City / Town:    State: RHODE ISLAND MASSACHUSETTS CONNECTICUT ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO DELAWARE COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY EW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING                ZIP:

   Email Address:    Phone:       Type:  Home Business Cell

Alternate Contact Information:

   First name:        Last name:   Position: Select one President Vice Pres. Treasurer Secretary Board Member Member Other

   Mailing Address:  Street: 

         City / Town:   State: RHODE ISLAND MASSACHUSETTS CONNECTICUT ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO DELAWARE COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY EW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING                 ZIP:

     Email Address:   Phone:        Type:   Home Business Cell

We wish to become an association member of Save The Lakes and have included  $50 with this application

       and wish to make an additional donation of     

 We do not wish to become a member at this time but would like to make a donation of     

   Signature ________________________                                                              Date:   

.      Make checks payable to :  Save The Lakes Inc.

 And mail it to:                     

                                       Save The Lakes

                                      61 Wood Road

              Chepachet, RI,  02814