MEMBERSHIP FORM

Lake Louise Community Non-Profit Corp.

Web site: www.lakelouisecommunity.info

Name:_________________________________________________________

Address:________________________________________________________

City, State, Zip Code:______________________________________________

Telephone Day:__________________Telephone Evening:________________

Cell Phone:___________________

E-Mail:__________________________________________________________

Lake Property Location:____________________________________________

Legal Location: US Survey Number;____________ Lot Number____________

Radio Call Sign:______________________________ Channel:_____________

Do you want to be included in the Lake Directory: YES        NO

Do you want E-Mail Newsletters:  YES        NO

Do you want to be on the Lake Louise Volunteer Fire Dept.:   YES      NO

DUES PAID TO:___________ New Member      Renewal

Annual Membership Fee:  Single $5.00     Family  $10.00    Donation_______

Emergency Information:

Mail To:                            Lake Louise Community Non-Profit Corp.

                                                 HC 01 Box 1684 B     Lake Louise Road

                                                 Glennallen, Alaska 99588