2021 MEMBERSHIP/DOCK SPACE FORM

COON LAKE COMMUNITY AND SENIOR CENTER

2021 MEMBERSHIP/DOCK SPACE FORM

 

NAME                         ____________________________________________DOCK SPACE NUMBER(S) ______________________

PARTNER/SPOUSE    ____________________________________________AMOUNT PAID ______________________________

ADDRESS ON CLB     _______________________________________________________________________________________

HOME PHONE   ______________________________________   CELL PHONE   _______________________________________

EMAIL ADDRESS       ____________________________________________       CHECK HERE IF RECEIPT IS NEEDED 

Residence Address (if different from above)  __________________________________________________________________ 

Landlord Name & Address (if Renter) ________________________________________________________________________

                                                                    ________________________________________________________________________

The Coon Lake Community & Senior Center (CLCSC) is a body of people who are concerned with the quality of life on Coon Lake Beach.  We provide support for local concerns, maintain and organize the Dock Space Program and maintain the Center (Clubhouse).  Memberships are available at volunteer (requires a minimum of 10 volunteer hours annually) and non-volunteer levels, with or without a dock space, but you MUST be a member in order to obtain a dock space.

As a member, you have an option to pay for, maintain and use up to two dock spaces.  While one space is available for every requesting resident in good standing, up to one additional dock space may be issued based on availability.  The additional space requires a payment at the non-volunteer level.  If you are renewing your dock space(s) indicate the number of dock space(s) by placing an “x” in the box directly to the right of the corresponding item and enclose payment for the correct amount as outlined in the cost of membership section.

 

 

1 Person Membership
No Dock Space

 

2 Person Membership No Dock Space

 

Dock Space 1

 

Dock Space 2

 

Dock Space 3

 

Volunteer

 

$30.00

 

$50.00

 

$100.00

 

$200.00

 

$200.00

 

Non-volunteer

 

$60.00

 

$100.00

 

$200.00

 

$200.00

 

$200.00

 

If you are interested in receiving a receipt for your payment, please indicate above and provide an email address.  A receipt will be sent to your email address.

Agreement with and adherence to the Coon Lake Community & Senior Center Dock Space Rules and Regulations for 2021 is required.  By signing this agreement, you agree to abide by all rules and regulations as stated.

By signing this agreement, you are verifying that you have current liability insurance in place to cover any claim against your dock and any personal property on your assigned dock space(s) and will not hold Coon Lake Community & Senior Center liable for any such claim.

The Coon Lake Community & Senior Center hereby grants the above-named person(s) the permission to use the dock space(s) designated above for a period of one year from May 1, 2021 to April 30, 2022.

THIS AGREEMENT MUST BE RENEWED ANNUALLY TO MAINTAIN YOUR DOCK SPACE PRIVILEGES.  PLEASE NOTE:  IF THIS FORM IS NOT COMPLETED, SIGNED, AND RECEIVED BY MAY 15, 2021 YOUR DOCK SPACE(S) MAY BE DECLARED OPEN.

For questions regarding membership, please contact any Officer or Director.  For questions regarding dock spaces, please contact Marlin Sanvick at (612) 702-3512. 

 

SIGNATURE            __________________________________________________________  DATE _______________________