Lake Mishnock Preservation Association
P.O. Box 240
Coventry, RI 02816
www.lakemishnock.org
MEMBERSHIP APPLICATION
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______________
