2005 Membership Application

(Please print form and mail to address below)


Name__________________________________________________________________

Street_________________________________________________________

City__________________________________________________

State______________________

Zip________________________

Phone________________________________

E-mail________________________________________________
          Memberships in the Blockhouse Lake Association are $25.00
Please mail your check to:
Corinne Fisher
Treasurer, Blockhouse Lake Association
N16206 Silver Birch Road
Park Falls, WI 54552-8125


Thank You!