Lake Mishnock Preservation Association
P.O. Box 240
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______________
