MEMBERSHIP APPLICATION

PLEASE  PRINT  CLEARLY

NAME: (LAST) __________________(FIRST) ___________________

ADDRESS: _______________CITY________________STATE_____ ZIP________

HOME PHONE: __________________

WORK PHONE: __________________ FAX __________________

E-MAIL ADDRESS: _____________________________________

SUMMER RESIDENCE________________________________
_____________________________________________________

SUMMER RESIDENCE PHONE__________________

MEMBERSHIP LEVELS
Tax Deductible

		Family / $25.00
		General / $15.00
		Bronze / $100.00
		Silver / $250.00
		Gold / $500.00
		Volunteer Option (I can't make a contribution at this time, but I am willing to be an involved member)
		Donation $________

Please make checks payable to:
Owasco Watershed Lake Assoc., Inc.
- All gifts are tax deductible as provided by law -
(Your membership will be up for renewal at the anniversary month of your check)

Copy and Mail to:
Owasco Watershed Lake Assoc., Inc.
P. O. Box 1
Auburn, NY   13021

What are the 3 main problems  you see Owasco Lake facing within the next decade?
1. _________________________________________
2. _________________________________________
3. _________________________________________

We need your participation! If you are able to help in any of the areas below, please check the appropriate boxes and an officer of the Association will contact you.

Communication / Newsletter Environmental & Conservation Issues Fund Raising Membership Drive Program Planning Landuse / Zoning Water Testing Publicity Other ___________ ________________

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