RENEWAL MEMBERSHIP APPLICATION

I (we) would like to renew our membership in the Harveys Lake Protective Association and commit that I (we) are current property owners or a business owner operating within the boundaries of Harveys Lake Borough.

Name(s): 

 ________________________________________________________________________________

Harveys  Lake  Address:  ______________________________________________________________

_________________________________________________________________________________________

Preferred Mailing Address (year round only): ________________________________________________

_________________________________________________________________________________________

Telephone Numbers and E-mail address (held confidential for HLPA business purposes only)

            Home Phone:________________________ Lake Phone:___________________________

Cell Phone:    ____________________________ Work Phone:________________________________

Email Address:______________________  Signature:_____________________________

Membership Application Date ________________

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Return with Annual Membership Dues in the amount of $30.00 to:

                                                Harveys Lake Protective Association

                                                P.O. Box 45

                                                Harveys Lake, PA 18618