MEMBERSHIP FORM

Please print out a hard copy of this form and mail it to:

Great Lakes Coalition
P.O. Box 429
Saugatuck, MI 49453
Telephone and fax: (269) 857-8945

Initial dues to The Great Lakes Coalition are $35. Some members have two residences. If you are one, please also complete the alternate address

Date: _____________

Name: __________________________________

Mailing Address:
________________________________________
________________________________________

Years on the Great Lakes shoreline: ______

Alternate Mailing Address:
_________________________________________
_________________________________________

Amount:
$35.00 _______ Other_______

Comments:
_________________________________________
_________________________________________
_________________________________________

Member Signature:
_________________________________________