Print & fill out form below and send your dues payment to:

Chippewa Lake Association ~PO Box 457~

Brandon, MN 56315

Year to apply dues_______________________   Amount enclosed  ($30)  ($48)  (Other)       $_______________

Name:________________________________________________________________________________________

Lake Address:_________________________________________________________________________________

Home Mailing Address__________________________________________________________________________

Telephone- Home______________________Lake___________________________Cell_____________________

Email address ______________________________________

(Yes)  (No)  I am interested in supporting a contribution of an additional $18 toward fish stocking.

$18 is too much, but I will contribute a different donation amount for fish stocking of $_______________