Buffalo, Rice, & Rock Lake Association (BRRLA) Membership Form

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* 1. Primary member first name

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* 2. Primary member last name

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* 3. Email for primary contact:

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* 4. Cell phone of primary contact:

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* 5. Do you give permission for BRRLA or lake captains to text you? Note, we will not provide your number to any vendors or sponsors.

Yes

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* 6. Names of other adults you want listed on your membership

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* 7. Secondary Email:

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* 8. Secondary cell phone:

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* 9. What lake are you on?

Buffalo

Rock

Rice

N/A - sponsor or donor

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* 10. Lake address

Lake Address

City

Zip

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* 11. Mailing address (if different than lake address):

Address

City/Town

State/Province

ZIP/Postal Code

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* 12. Membership Type:

Owner/Year-round renter ($20)

Seasonal Renter/Campground Tenant ($10)

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* 13. Donations:

Please enter the amount of any additional financial donations you wish to provide to BRRLA.

Please describe any in-kind donation you wish to provide BRRLA.

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* 14. If you have any questions, ideas, or comments for the BRRLA Board please share below.

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* 15. Do you have an interest in lake swag? If so which of the following would you like to purchase the most?

t-shirts

Sweatshirts

hats

stickers

mugs

Other (please specify)