ORGANIZATIONAL FORM
(Print form if purchasing by mail. Please enclose a self-addressed stamped envelope - $.58 postage required )

CARBON COUNTY PARKS & RECREATION DEPARTMENT
Mauch Chunk Lake Park
625 Lentz Trail
Jim Thorpe, PA 18229-1902
Telephone 570-325-3669 - Fax 570-325-4166

2010 Organization Memberships (Web Site Form)

Carbon County Resident

  

Non-County Resident

Up to 20

  $ 60.00

 

Up to 20

  $ 105.00

21 to 40

  $ 85.00

  

21 to 40

$ 170.00

41 to 60

$ 105.00

 

41 to 60

$ 230.00

61 to 80

$ 120.00

 

61 to 80

$ 280.00

81 to 100

$ 130.00

 

81 to 100

$ 320.00

Please include dates that your group will be attending the Park

If your organization is planning to buy lunch at the beach concession stand. Please call the concessionaire stand
at (570) 325-3305

So they can prepare accordingly.
Please print.

Organization Name

Supervisor's Name

Phone

Address

City

State

Zip

Email

Please supply email address if you are interested in receiving notice of park events during the season.

Signature

  
 

Date

If purchasing by mail please enclose a self-addressed stamped envelope - postage is $.51.
Make check payable to: Carbon County Parks & Recreation Fund
THANK YOU

Please be advised, all counselors should wear identifiable  clothing (i.e. t-shirts, hats, etc.), so that the park staff can readily identify them as councilors in the case of an emergency.

For Office use only: No.