Membership Renewal/Application

KCA Lake membership: 
	Wadsworth Lake / Dam Lake / Campbell Lake / Kuiack Lake / Frank Lake / Long Lake 

===================================================================================

Member(‘s) name(s):

Home street address: 
City/Town:                                                             
Prov:                                
Postal Code:      
      
Email:              
Res.phone:                 
Cell phone:  
Cottage/property phone: 

Cottage/property address (civic address = 911# = Fire#):   
 
Cottage Lake: 
 
 
Membership fee: $20/year

Email address for e-transfer:  membershipKCA@gmail.com   (autodeposit) 
(if e-transferring, please also email this completed form separately to this same email address) 
 
Land mailing (if mailing cheque):  Ryszard Naranowicz 
                                                   260 The West Mall, Etobicoke, ON  
                                                   M9C-1C5  
  
===================================================================================

KCA Executive contacts: 

	President: Sophia Sudnikowicz               Res: 613-298-7157 sophmeister@bell.net

	VP/Secretary: Vacant

	Treasurer: Ryszard Naranowicz              Res: 416-622-8422 r-naranowicz@rogers.com  
                                                                         Cell: 416-710-2827 
 
	Communications Director: Roman Jagla  Res: 416-762-9906 rsjagla@sympatico.ca