Lake Mishnock Preservation Association

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Membership Application Form

Lake Mishnock Preservation Association             
P.O. Box 240
Coventry, RI 02816
First Name_____________________ Last Name___________________
Mailing Address_____________________________________________
Email Address ______________________________________________
Home Phone ________________ Other Phone___________________
Would you like to serve on a committee? Yes___ No___
Do you have any special skills helpful to LMPA?
If so, please explain ________________________________________
I am at least 18 years old and support the following mission statement:
Lake Mishnock Preservation Association, a nonprofit, all-volunteer
organization, is dedicated to the safety, improvement, and protection
of Lake Mishnock and strives to ensure its biological integrity and
natural beauty for generations to come.
I hereby apply for membership
Individual $25___                   Household $35___
____AND, I wish to make an additional donation of $_____
____I have donated $100 or more and wish to apply for membership
____I am donating $________, but do not want to become a member
Signature____________________________ Date______________