KLCOA MEMBERSHIP
R.R.#1 Kennisis Lake,
HALIBURTON, ON. K0M 1S0

MEMBERSHIP RENEWAL FOR THE YEAR 2008.

MEMBERSHIP IN THE KLCOA PROVIDES FOR:
- FIRE SERVICES                                                        - PARTICIPATION IN REGATTAS
- COMMUNITY POLICING                                            - FIREWORKS
- TWO NEWSLETTERS PER YEAR                          - INFORMATION SHARING
- FORUM FOR DISCUSSION AND DEBATE
- REPRESENTATION ON ISSUES OF CONCERN BOTH LOCALLY AND PROVINCIALLY

PLEASE COMPLETE THIS FORM AS SOON AS IT IS RECEIVED AND EITHER SEND IT TO THE ABOVE ADDRESS OR PLACE IT IN THE DROP BOX AT THE MARINA STORE ( THE MARINA STORE WILL BE OPEN IN MAY). DON’T FORGET TO INCLUDE YOUR CHEQUE OR MONEY ORDER MADE OUT TO THE KLCOA.

FEE FOR THE YEAR 2008 IS $30.00- $35.00 After July 1st.

RESIDENTIAL INFORMATION

NAME OF OWNER ______________________________________________________________

RESIDENTIAL ADDRESS _________________________________________________________

CITY OR TOWN _______________________________  POSTAL CODE __________________

RESIDENTIAL TELEPHONE NUMBER______________________________

LAKE INFORMATION

OUR COTTAGE/HOME IS LOCATED AT SEQUENTIAL LOT NUMBER ____________ ON

_________________________________________________________.
(NAME OF ROAD OR DRIVE)

IF OWNERSHIP OF YOUR LAKE PROPERTY HAS CHANGED SINCE LAST YEAR, PLEASE GIVE DETAILS.

PLEASE NOTE:  THE INFORMATION ON THIS PAGE WILL BE SHARED ONLY WITH KENNISIS COMMUNITY POLICING TO BE USED ONLY IN THE EVENT OF AN EMERGENCY.

QUESTIONS MAY BE DIRECTED TO ANY MEMBER OF THE EXECUTIVE OR CONTACT THE PRESIDENT BY E-mail AT: menbership@klcoa.org.