PRINT AND

MAIL TO:

LOON LAKE HOMEOWNERS ASSOCIATION

PO BOX 219

(LOON LAKE)

VERMONTVILLE, NY 12989

2009-2010 MEMBERSHIP DUES

$30.00

 NAME:__________________________________________________________

CAMP NAME: _____________________________________________

LOCAL ADDRESS:________________________________________________________________

__________________________________________________

TELEPHONE:____________________________________________

PERMANENTADDRESS:___________________________________________________

__________________________________________________

TELEPHONE: _______________________________

E-MAIL ADDRESS: _______________________________________

(CHECK PREFERRED MAILING ADDRESS)

PLEASE CHECK TOPICS FOR WHICH YOU ARE WILLING TO VOLUNTEER YOUR TIME:

_________ BOATING REGULATION SAFETY

_________ ACTIVITIES

_________ ENVIRONMENT (WATER QUALITY & CONSERVATION)

_________ COMMUNICATIONS

_________ LEGAL/ACCOUNTING

_________ BEACH