Koronis Lake Association Membership Form
Annual information gathering. Please respond to questions below. The first name and address questions are required, the rest of the form is optional. Thank you for your participation.
Name: *
Your answer
Street Address (Permanent): *
Your answer
City: *
Your answer
State Abbreviation: *
Your answer
ZIP: *
Your answer
Home Phone:
xxx-xxx-xxxx
Your answer
Cell Phone:
xxx-xxx-xxxx You may include comment, e.g., "John's cell"
Your answer
Additional Phone:
Your answer
I would like to receive my newsletter by: *
Required
Email:
Your answer
Additional Email:
Your answer
***Lake Address, if not permanent resident.
Street (LA):
Your answer
City (LA):
Your answer
State (LA):
Your answer
ZIP (LA):
Your answer
***Alternate (typically, winter) Address
(NOTE: In Development: ability to mail newsletter to alternate address)
Alternate Address Beginning Date
MM
/
DD
/
YYYY
Alternate Address Ending Date
MM
/
DD
/
YYYY
Street Address or PO Box (Alt):
Your answer
City (Alt):
Your answer
State Abbreviation (Alt):
Your answer
ZIP (Alt):
Your answer
***Would you like to donate?
If so, respond below and either mail check payable to "Koronis Lake Association: to:
Koronis Lake Association
P.O. Box 333
Paynesville, MN 56362
OR - to pay with credit card or PayPal, click on link on confirmation screen that will be displayed after you SUBMIT
Yes, I want to help protect and improve the water quality and beauty of Lake Koronis:
I would like to support annual fireworks on Lake Koronis:
I would like to support the effort against AIS:
***Opportunities to Participate
Listed below are a few opportunities to get involved in KLA. Please indicate the projects you are interested in
so KLA Board members can contact you. I/We would like to support the Association by volunteering my/our
time in the following way:
If you have any suggestions/comments please let us know below. Type as long as you like. This field will add rows as necessary. Thanks!
Your answer
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