Name: _______________________________________________________________
Birthday (m/d): ________________________________________________________
Address: _____________________________________________________________
Home Phone: ________________________Cell Phone: ______________________
E-Mail: _______________________________________________________________
Amount Paid: _________________________________________________________
Seasonal Address: _____________________________________________________
Thank you for completing and returning this form to Lauri Aquino (741 Patty Lane, Webster, NY 14580) This will help us account for dues paid and update the directory as needed.