BLPA Membership Application

Membership & Renewal Form

Please complete as you’d like it to appear in the association’s directory and for mailings to you throughout the year. Your information will not be shared with anyone else. (BLPA is a 501(C) 3 organization so your dues can be tax deductible.) Thanks for your support.

"*" indicates required fields

Membership Type*

New Member

Renewal

Name*

First Last

Spouse Name

First Last

Email*

Cell Phone

Primary Address (Mailing)*

Street Address Address Line 2 City State ZIP Code

Phone

Do You Have a Secondary Address?

I have a secondary address.

Secondary Address*

Street Address City State ZIP Code

Phone

Level of Support*

Supporter: $35-99 per year. Sponsor: $100-499 per year. Benefactor: $500 and over per year.

BLPA Membership Application

Membership & Renewal Form

More About Us

Preserving the Waves of the Future

Burt Lake Preservation Association