Membership Application

Please print this application, complete the information and
mail to the address at the bottom of the page
Name

Address

City, State and Zip Code

_______New

_______Renewal

_______________________________________

_______________________________________

_______________________________________

_______Full Membership ($15.00)

_______Associate Membership ($5.00)

Lake Address if different than above,

Address

City, State and Zip Code

_______________________________________

_______________________________________

Comments__________________________________________________________

___________________________________________________________________

___________________________________________________________________

Mail with Check or Money Order to:

Sherry Watson, treasurer
Black Lake Association
2996 County Route 6
Hammond, NY 13646

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