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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.

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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?

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* 10. Lake address

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

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* 12. Membership Type:

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* 13. Donations:

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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?

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