Membership Application

2024 Membership Application 

Name (s): ___________________________________________________________ 

Lake Address: ______________________________________________________ 

Summer Mailing Address (if different than lake address) Winter Mailing Address (if different than summer address) 

Lake Phone: ________________Cell Phone: ________________

Other Phone: ______________ 

e-mail address: ______________________________________________________

Would you like to receive Newsletters etc. by e-mail rather than US mail?

Yes ______ No ______ 

I am particularly interested in seeing the Lake Association do the following: 




I would like to participate in the following committees: _____ AIS Monitoring _____ Shoreline Restoration _____ Public Access _____ Fund Raising / Grant Writing _____ Social Committee  _____ Other ______________________________ 

_____ _I would like my name placed on the ballot for a Board of Directors position. 

_____ _Enclosed is my tax deductible membership dues of $25. 

_____ _Enclosed is my additional tax deductible donation of $__________ in support of UHLA’s mission 

to promote environmental stewardship throughout the Upper Hay Lake area. 

Make check payable to Upper Hay Lake Association and mail to: 

Upper Hay Lake Association P.O. Box 769 Pequot Lakes, MN 56472