PLEASANT LAKE & PARKER POND ASSOCIATION

2016 MEMBERSHIP AND RENEWAL APPLICATION

Please enroll me as a member of the Pleasant Lake & Parker Pond Association. Annual

dues cover the current calendar year.  Membership is open to anyone interested in

preserving the quality of Pleasant Lake and Parker Pond.

Enclosed is my check payable to the Pleasant Lake & Parker Pond Association.

I would like to renew or join at the following level:

                                 _____ $                 -  Higher Amount

                                 _____ $ 250.          -  Provider

                                 _____ $ 200.          -  Supporter

                                 _____ $ 100.         -  Benefactor

                                 _____ $  50.           -  Patron

                                 _____ $  25.          -  Membership

PL/PPA IS A FEDERAL 501(C)(3) TAX EXEMPT CORPORATION

For donations of $250 or more, you will receive a receipt to include with your tax return.

NAME(S)___________________________________________________________

Permanent Mailing Address_____________________________________________

Tele:________________________________Fax: ____________________________

Seasonal Mailing Address: _____________________________________________

Tele:________________________________Fax:_____________________________

Date:_____________________Email: _____________________________________

   

Mail to:    Pleasant Lake & Parker Pond Association

                 983 Meadow Road              

                 Casco, ME 04015

THANK YOU FOR YOUR SUPPORT