Flathead Lakers Membership Form

Please mail completed form to Flathead Lakers, P.O. Box 70, Polson, MT 59860

Home Address

Name:

Address:

City & ST:

Zip:

Telephone:

Fax:

Email:

Summer Address

Name:

Address:

City & ST:

Zip:

Telephone:

Fax:

Email:

Classes of Membership
$40 - Member$75 - Sustainer
$100 - Patron$250 - Benefactor
$500 - Protector$1,000 - Advocate
$_______ Other