Membership Period: August 2010 - July 2011

Please complete the information below, enclose your check payable to DLIA

and mail to:

DLIA

P.O. Box  889

Newport, WA 99156

NAME:                                                                                                                                   

LAKE ADDRESS:                                                                                                                  

MAILING ADDRESS:                                                                                                    

CITY, STATE, ZIP:                                                                                                                

E-MAIL:                                                                                                                                 

Household $25.00

Single $15.00

I/we would like to contribute an additional donation:

Milfoil                 $                     

Fireworks           $                     

Fire Dept            $                     

Fish Pen             $                     

Other                 $