Contact Information

Name: _____________________________________________________

Address: ___________________________________________________

Telephone: _________________________________________________

Mobil Phone: ________________________________________________

Fax: _______________________________________________________

E-mail: _____________________________________________________

Alternate Contact Information (if applicable)

Alternate Address: ___________________________________________

Alternate Telephone: _________________________________________

Alt. Address(2): _____________________________________________

May we send mailings to these addresses?

( ) Yes
( ) No

If yes, this is your:

( ) Summer Address
( ) Winter Address

Contact Preference

How would you prefer to be contacted?

( ) E-mail
( ) Regular Mail
( ) Both (E-mail alerts and paper version of newsletter)

Please mail to:

Geneva Lake Conservancy
398 Mill Street
P.O. Box 588
Fontana, WI 53125

Phone: (262) 275-5700
Fax: (262) 275-0579

Email: glc@genevaonline.com - copy and paste the information into the body of the email. Thanks!