Membership Application & Annual Meeting Sign Up Form ILA Membership Application To apply for membership complete all questions. Please send payment to Treasurer, ILA, PO Box 973 Sabael, NY 12864 or bring check or cash to the Annual Meeting, or pay via bank ACH transfer (ie Bill Pay). If paying by ACH Transfer, use your first and last name as your account number. Make payments payable to "Indian Lake Association, ADK, Inc." You can also now pay by credit card by completing the credit card information below. New or renewing membership? (If renewing please complete all info even if you think we have it.) Please Select New Membership Renewal Name First NameLast Name Home Address Street Address Street Address Line 2 CityState / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country E-mail example@example.com Home Number Cellular Number Camp Number Camp Address Street Address Street Address Line 2 CityState / Province Postal / Zip Code Are you willing to participate in the ILA Networking Directory? Yes - I would love to be a mentor - send me more infoYes - I need mentoring - sign me upNope If interested in the ILA Networking Directory - provide area of expertise/interest. Attending the Annual Breakfast Meeting? Please Select Yes No Maybe How Many attending? Breakfast. Non-members $20. Children under 12 $10. Please Select 1 2 3 4 5 At our annual meeting, we will be electing one director to succeed Autumn Blanchard whose last term is 2024. Also, Glenn Van Norstrand, Daniel Way and Jon Voorhees will stand for re-election in their respective offices. I will not be attending the Annual Meeting, I hereby designate Helen Glass, ILA Secretary as my proxy for all matters that come before the board. Signature Method of Payment Please Select Mail Check to PO Box ACH Bank Transfer Pay at meeting Credit Card (via Square) Date -Month -DayYearDate Membership Levels prevnext( X ) GOLD Membership - 3 Year$80.00 SILVER Membership - 2 Years$55.00 BRONZE Membership - 1 year$30.00 Donations Gladly Accepted & Greatly AppreciatedPlease choose your donation amount by choosing quantities in multiples of $10.00$10.00 Quantity 1 2 3 4 5 6 7 8 9 10 Credit Card Please verify that you are human* ContinueContinue Should be Empty:
