The Thousand Islands Association

MEMBERSHIP APPLICATION

PLEASE PRINT AND COMPLETE THIS FORM  AND FAX IT TO 315-233-0347
OR SEND IT TO THE CORRESPONDING ADDRESS BELOW ALONG WIH YOUR 
CHEQUE FOR:  $30$75$1000

NAME(S):____________________________________________________

WINTER ADDRESS:___________________________________________

STREET:____________________________________________________

CITY:_______________________________________________________

STATE/PROV:________________________________________________

ZIP/POSTAL CODE:____________________________________________

TELEPHONE:_________________________________________________

SUMMER ADDRESS:__________________________________________

STREET/ISLAND:_____________________________________________

CITY:________________________________________________________

STATE/PROV:_________________________________________________

ZIP/POSTAL CODE:____________________________________________

TELEPHONE:_________________________________________________

CANADA	U.S.A.
P.O. BOX 274 Gananoque, ON K7G 2T8 Canada	P.O. BOX 718 Wellesley Island, NY 13640 U.S.A.