You can either print this page or print the the Microsoft Word version of the membership form. Please send your form and payment to the address below. For more information, please contact your nearest Association Director or Zone Representative.

Annual membership fee is $20.00, a portion of which covers the levy for membership in the Federation of Ontario Cottagers’ Association (FOCA)

Name:_______________________________________________________

Home mailing address: _________________________________________

                                        ________________________ Code: ___________

Golden Lake 911 address: _______________________________________

                                         _________________________Code: __________

Telephone: (home)         _________________________

                 (cottage)         _________________________

Email(s): _______________________  ________________________

Cottage Watch – Please indicate if you are interested in registering for this

Crime Prevention Program      Yes ________    No ________

 GLPOA Zone (1-10):  ____  Zone Director: _____________________      

Membership Card Number: ________________

Paid to: ____________________________  Date: ________________

Treasurer’s receipt: ___________                     Registrar: ____________

Please be sure to submit complete information to ensure accurate records by the Association.  Be advised that GLPOA respects the privacy of your information and will not, in any way, divulge personal data to a third party.