Annual Membership and Renewal Application
Join other like-minded people, local businesses, home owners’ associations and organizations to help the Lake Wisconsin Alliance (LWA) improve the water quality and experience of the lake we love.
Mission Statement: The LWA endeavors to balance the diverse interests of the Lake Wisconsin community while improving water quality, recreational opportunities and sustaining a healthy ecosystem within the Lake Wisconsin watershed.
Last Name: ____________________________ First Name: ____________________________
Mailing Address: _______________________________________________________________
City, State, Zip Code: ____________________________________________________________
Phone Number: ___________________________________________
Email Address: _________________________________________________________________
If applying as a business, Name of Business: _________________________________________
Membership Level:
______ Individual Annual Membership $20.00 ______ Business Annual Membership $50.00
______ Additional Contribution of $______________
Membership is for the current calendar year.
Join/give on our website at: www.lakewisconsinalliance.org or by completing and mailing this application form to the address below. Make checks payable to “Lake Wisconsin Alliance” and
submit to:
Lake Wisconsin Alliance
PO Box 172
Poynette, WI 53955
Contact: Kirk Boehm | 608-635-8851 | info@lakewisconsinalliance.org
Lake Wisconsin Alliance is a tax exempt 501(c)3 organization. Your contribution is tax deductible. Thank you for your support. It is greatly appreciated.
