BalsamLake Community Club     P.O. Box 366      Balsam Lake, WI 54810

MEMBERSHIP APPLICATION

January 1, 2008 - December 31, 2008

NAME(S): ____________________________________________________________________

         [Please Print]

MAILING ADDRESS: _________________________________________________________

         [Street/PO Box]     [City]     [Zip Code]

PHONE NUMBER: ______________________ E-MAIL: _____________________________

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SPECIAL INTERESTS:

______________________________________________________________________________

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  Please Submit Application & Dues to:
BalsamLake Community Club/Membership P.O. Box 366   Balsam Lake, WI 54810

Dues:   Individual   $10.00    ~    Family     $15.00    

Silver Contributor: $50

Gold Contributor: $250
Platinum Contributor: $500.00