Name____________________________________________________________
Address__________________________________________________________
City, State, Zip Code________________________________________________
Phone: Home_______________________Lake__________________________
E-Mail Address_____________________________________________________
Lake Homeowner__________(Y/N) Other_______________________________
Lake Area_________________________________________________________
Lake Address______________________________________________________
Year Lake Home Originally Built______________
Annual Marine 9 Fireworks Memorial Utility Boat Scholarship
Dues Donation Donation Gift Donation Fund
$25.00 $_______ $_______________ $_________ $_________ $_________
Memorial gift in memory of:___________________________________________
New Membership________(Y/N) Renewal Membership__________(Y/N)
Please make checks payable to Lake Mitchell H.O.B.O.
Send to: P.O. Box 1324
Clanton, AL 35046
IDEAS/COMMENTS:
__________________________________________________________________
__________________________________________________________________
THANK YOU FOR YOUR SUPPORT - 2009 OFFICERS & BOARD OF DIRECTORS
