*E-Mail Address:

Please Note: We will not sell or give out your email address. By completing this application you hereby give us permission to send you periodic announcements, updates and newsletters as relates to the functions and business of Grand Lakers United Enterprise via email. Please put the following address in your email address book or buddy list today:

*Salutation: Select from below: Mr. Mrs. Ms. Miss Dr.

*First Name: MI:

*Last Name:

*Mailing Address:

Add'l Address (Apt. #, Suite, etc.):

*City:

*State: *Zip Code: Zip +4:

*Desired Membership Level: Select one from below: Diamond - $5,000/yr. Platinum - $1,000/yr. Gold - $500/yr. Individual - $100/yr.

(Note: Memberships in the name of a business are not allowed in the "Individual" level category.)

Lake Interests (Select all that apply):

Shoreline Management

Water Quality

Commercial Development

Residential Development

Environment

Fishing

Hunting

Sailing

Boating

Camping

Other

Explain if "Other" was selected:

*Please tell us the general location of your lake property:

(e.g., Duck Creek, Monkey Island, Zena area, etc.)

*Are you a full-time lake resident? Select from below: Yes, full-time lake resident Not now but plan to be Weekender

Company Name:

Contact Name:

Contact Phone:

Contact Cell:

*Desired Password for Members Only area login:

(6-12 characters or numbers - no special characters)

Thank you!

If any required fields need additional input you will be returned to the form and asked to provide the required information.

Please note: This form is protected with BoxTrapper. When you Submit the form you will receive an email asking you to REPLY, leaving the subject and everything else intact. Simply hit REPLY. This tells the form routine you are probably really a human wanting to submit the form instead of an automated form robot attempting to send us SPAM. We apologize for the extra step and inconvenience. Such are the times in which we live.

Click SUBMIT to send application:

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