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  ($15)  ($35)  (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 $20 toward fish stocking.

$20 is too much, but I will contribute a different donation amount for fish stocking of $_______________