PERCY LAKE RATEPAYERS’ ASSOCIATION
MEMBERSHIP REGISTRATION-2011
NAME: ______________________________
PERCY LAKE ADDRESS: ______________________________
HOME ADDRESS: ______________________________
TELEPHONE:
HOME: ( ) _____________________________
COTTAGE: ( ) _____________________________
EMAIL ADDRESS: ______________________________
Registration Fee - $20.00
Please make cheque payable to the Percy Lake Ratepayers’ Association
Send cheque and form to: Jack Russel
If you do not want your name and/or phone number to be included on next year’s emergency phone number list for the lake, please sign here and return this form with your membership fees.
Do NOT place my name/numbers on the emergency list:
Signature: _______________________________________________