*E-Mail Address:

*Salutation: Select from below: Mr. Mrs. Ms. Miss Dr.

*First Name: MI:

*Last Name:

*Mailing Address:

Add'l Address (Apt. #, Suite, etc.):

*City:

*State: *Zip Code: Zip +4:

*Desired Membership Level: Select one from below: Diamond - $5,000/yr. Platinum - $1,000/yr. Gold - $500/yr. Individual - $100/yr.

(Note: Memberships in the name of a business are not allowed in the "Individual" level category.)

Lake Interests (Select all that apply):

Shoreline Management

Water Quality

Commercial Development

Residential Development

Environment

Fishing

Hunting

Sailing

Boating

Camping

Other

Explain if "Other" was selected:

*Please tell us the general location of your lake property:

(e.g., Duck Creek, Monkey Island, Zena area, etc.)

*Are you a full-time lake resident? Select from below: Yes, full-time lake resident Not now but plan to be Weekender

Company Name:

Contact Name:

Contact Phone:

Contact Cell:

*Desired Password for Members Only area login:

(6-12 characters or numbers - no special characters)

Thank you!

Please tell us what you are changing or make any comments you desire:

If any required fields need additional input you will be returned to the form and asked to provide the required information.

Click SUBMIT to send application:

Click RESET to clear form and start over: