SHENIPSIT LAKE ASSOCIATION MEMBERSHIP FORM

Please complete the information below and indicate the amount you would like to donate to become a member of the SLA.
Print the form and enclose a check for the amount indicated.

Please make the check payable to Shenipsit Lake Association, and mail to:

Shenipsit Lake Association - Membership
PO Box 1475,
Vernon, CT 06066

If you have any questions, please feel free to contact us.
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Name:______________________________________________________________________________


Address:____________________________________________________________________________


Town:__________________ State:__________________ Zip Code:__________________


Telephone:_________________________ E-Mail:___________________________________________

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Optional Information:

Place of Employment:_________________________________________________________________

Club Associations (Autobon society, CFFA, etc):___________________________________________

The above information is purely optional and therefore not required when submitting this form. SLA does not base participation in
the association based on any part of this optional information.
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Because the SLA is involved in many activities at the Lake, there is a great need for volunteers to
join committees or help out with events. Please check any committee/s or event/s you would like to serve on.