Please send annual $10.00 dues to:
Loon Lake Park District Association
P.O. Box 301
Chestertown, New York 12817

Make the check payable to LLPDA.
Please complete the form so we can keep our records updated.
(Golf Tourney checks separate)

PRINT THIS PAGE AND RETURN THIS FORM WITH YOUR DUES
Name
Mailing address
Local address (include house number)
Summer address if different
Phone (local)
(home)
Email Address
Sponsor a new member - try to win the beautiful carved loon - send info and their paid
dues, a newsletter will be forwarded to them and you name included in the drawing.
Name
Mailing address
Local address (include house number)
Mailing address
Phone (local)
 (home)
Emial
GOLF TOURNAMENT REGISTRATION - $65.00 PER PERSON

Friday, August 11, includes greens fees, golf cart, beverages on the course, lunch and prizes. PLAYERS MUST ARRIVE BY 8:15 AM to be checked in and be on the course for the 9AM shotgun start.

Please write a check separately from your dues.
Chairs: Arnold Jensen 494-3581, Ralph Smith 494-2290. Cronin members, check flyer for proper fees.
LLPDA Member's name
Number of people in group
Local Phone (518)
 Home Phone (----- )
Team Members