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

Members

Friends of the Flathead

$25 - Member

$100 - Patron

$50 - Sustainer

$250 - Benefactor

$___ Other

$500 - Protector