YES! SIGN ME UP TO SUPPORT PCLA!

Please print this form and mail with check to:
PCLA • P.O. Box 211 • Conway, MI 49722

Name (s):_____________________________________________________________

Summer Address: _______________________________________________________

Winter Address: _________________________________________________________

I live in: ___Littlefield Township  ___Springvale Township  ___Little Traverse Township  ___Bear Creek Township ___Village of Alanson

___ Send to winter address year-round
___ Send to summer address from _______________ to _________________
Summer Phone: ____________________ Winter Phone:__________________________

E-mail address: _________________________________________________________

____ Sign me up to communicate with PCLA members via e-mail
____ Send my newsletter via e-mail    
____ Send my newsletter by "snail mail"
____ Do not include my name in the PCLA member directory
CONTRIBUTIONS ENCLOSED
Tax-Deductible Non Tax-Deductible
$ 25.00 annual membership
$ 40.00 business membership*
$ ____ for the PCLA aquatic plant survey
$ ____ for the PCLA land acquisition fund
$ ____ in honor of _________________________
$ ____ in memory of _______________________
$ ____ to support special PCLA projects
$ ____ TOTAL TAX DEDUCTIBLE

In addition to my dues, please send me: (shipping included)
$ ____ Boat Flag ($22.50)
$____ License Plate ($5.00)
$ ____ Metal Driveway Reflector ($14)
$ ____ Decal ($3.50)
$ ____ TOTAL non-tax-deductible

Tax-Deductible + Non Tax-deductible = Total enclosed: _______________________________

*(Your business membership includes listings on PCLA website and in newsletters)

Business name: _____________________________________________________________

Address, City, State, Zip______________________________________________________

Business web site: ___________________________________________________________


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