Membership Form — Bantam Lake Ski Club

First Name

Last Name

Primary Phone

(###)

###

####

Secondary Phone

(###)

###

####

Primary Email

Secondary Email

Membership Type

Individual: $75 Membership + $25 BLPA

Family: $150 Membership + $25 BLPA

Student: $25 Membership + $25 BLPA

Lifetime Member: $25 BLPA

Family Membership Names & Ages

Leave blank if individual membership

School/University

for full-time student memberships only

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Boat Slip

Do you currently rent a ski club boat slip/wish to be on the wait list?

Yes

Join the waitlist