Application for Membership

Application for Membership
Long Pond Watershed Association

Please print out this form, complete it, and mail it, along with your check for annual dues* of $25 (US), to

Long Pond Watershed Association
P.O. Box 1373
East Harwich, MA 02645

* Dues are voluntary contributions, used to defray operating expenses of the Association. Payment of annual dues establishes you as a voting member of LPWA -- you may join as a non-voting member without paying dues.

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First name:

Last Name:

	On-Cape	Off-Cape
Street Address:
City:
State:
Zip:
Telephone:
FAX:
Email:

Where would you like notices from the Association mailed to you?

Off-Cape Address

On-Cape Address

If you'd like to volunteer your services, please tell us, in the space below, how you can help:

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