2010 ELLOA DUES REMITTANCE

Dues are $30 per family membership. $_________Total Amount Paid

Please pay by May 18, 2010(effective June 2010 to June 2011).

Name: _____________________________________________________________

Number of Family Members: ________adults ________children

Lake Address: _______________________________________________________

Lake Phone: _______________________________________

Permanent Address: __________________________________________________

City ________________________ State _________ zip code _________________

Permanent Phone: _________________________________

E-Mail:____________________________________________________

You can allocate up to 50% of your dues to the Fish fund.

How much of your dues do you want to contribute to the Fish Fund? ____$0 ____$5 ____$10 ____$15

If contributing more than the $30 dues, please indicate how much of the extra goes to which funds.

$_________Conservation & Preservation Fund $_________Legal Fund

$_________General Fund $_________Fish Fund

The Michigan Riparian magazine is free with your membership; would you like it mailed to you? ____yes ____no

Please mail payments to: Evans Lake Landowners Association

1044 Breyman Hwy., Tipton, MI 49287