OFFICIAL NAME OF LAKE ASSOCIATION:
__________________________________________________________________

LAKE ASSOCIATION ADDRESS: __________________________________________________________________

Total Membership________ Estimated Number eligible for membership_________

ASSOCIATION NEWSLETTER :
       Editor: _________________________ Mailing Address _________________
        EMail Address ________________________________

OFFICIAL REPRESENTATIVE TO FORUM:

Name__________________________________Address_______________________________________________

Phone______________________________________ eMail_____________________________________
         CURRENT OFFICERS OF ASSOCIATION:

President:
Name _____________________________________Address________________________________________
               
                      Phone___________________________e-mail______________________
Vice Pres:    Name_____________________________________Address__________________________________________
              
                      Phone__________________ e-mail__________________________
Secretary:    Name___________________________________Address_____________________________________________
               
                      Phone___________________________e-mail______________________
Directors:
                Name......................................................Address______________________________
               
                      Phone______________________________eMail___________________
             :
                Name......................................................Address___________________________________
               
                      Phone____________________________e-mail_____________________
             :
                Name.....................................................Address_________________________________
               
                      Phone__________________________eMail___________________________

Is your association incorporated as a non-stock, non-profit corporation? ____________
President (or authorized representative)(signed) _____________________________________Date______