2010 HLPA MEMBERSHIP APPLICATION

I (we) request consideration for membership in the Harveys Lake Protective Association and commit that I (we) are current property owners or a business owner operating within the boundaries of Harveys Lake Borough.

Name(s):  ________________________________________________________________________________

Harveys Lake Address: _____________________________________________________________________

_________________________________________________________________________________________

Preferred Mailing Address (year round only): ____________________________________________________

_________________________________________________________________________________________

Telephone Numbers and E-mail address (held confidential for HLPA business purposes only)

Home Phone: ________________________________ Lake Phone: __________________________________

Cell Phone: __________________________________Work Phone:__________________________________

E-Mail Address: ______________________________ Signature: ____________________________________

Membership Application Date  _______________

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Return with Annual Membership Dues in the amount of $30.00 to:

                                                Harveys Lake Protective Association

                                                P.O. Box 45

                                                Harveys Lake, PA 18618

updated Jan 11, 2010