
| Pine Lake Association | |||||||||
| Membership Card & Directory Update | |||||||||
| Names | Dues: | $25.00 | |||||||
| Lake Address | Fireworks: | ||||||||
| Mailing Address | Buoy Fund: | ||||||||
| City | Donation | ||||||||
| State & Zip | Buoy Fund | ||||||||
| Lake Phone | Weed Control | ||||||||
| Phone 2 | Survey | ||||||||
| Email Address: | Total $ | ||||||||
| Residential Status Seasonal ____ Year Around ____ | |||||||||
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Are you willing to receive your PLA Newsletter by E-mail? Yes____ No____ |
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| Are there any changes to your lake, mailing, or E-mail address(s) since last update? Yes____ No____ | |||||||||
| Please check if you do not want your personal information published in the new PLA Directory:_____ | |||||||||
| Are you interested in becoming a board or committee member? Yes___ No___ | |||||||||