2021 Membership Application
Name (s): ___________________________________________________________
Lake Address: ______________________________________________________
Summer Mailing Address (if different than lake address) Winter Mailing Address (if different than summer address)
Lake Phone: ________________Cell Phone: ________________
Other Phone: ______________
e-mail address: ______________________________________________________
Would you like to receive Newsletters etc. by e-mail rather than US mail?
Yes ______ No ______
I am particularly interested in seeing the Lake Association do the following:
I would like to participate in the following committees: _____ AIS Monitoring _____ Shoreline Restoration _____ Public Access _____ Fund Raising / Grant Writing _____ Social Committee (Picnic / Breakfast) _____ Other ______________________________
_____ _I would like my name placed on the ballot for a Board of Directors position.
_____ _Enclosed is my tax deductible membership dues of $25.
_____ _Enclosed is my additional tax deductible donation of $__________ in support of UHLA’s mission
to promote environmental stewardship throughout the Upper Hay Lake area.
Make check payable to Upper Hay Lake Association and mail to:
Upper Hay Lake Association P.O. Box 769 Pequot Lakes, MN 56472