MEMBERSHIP FORM
(Print this form and send in with a check or money order and a self addressed stamped envelope.)
($.58 postage required.)

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

Application for 2009 Season Membership (Web Site Form)

CARBON COUNTY RESIDENT

$40.00 for Family Membership - if purchased by May 31, 2009
$45.00 for Family Membership - if purchased starting June 1, 2009
$25.00 for Individual Membership - if purchased starting May 31, 2009
$20.00 for Individual Membership - if purchased by June 1, 2009

*If you are applying for a county membership and are a non-county resident you must show proof of owning county property with you current county tax bill. If mailing membership form attach a copy of the county property tax bill with your membership form.

NON-COUNTY RESIDENT

$75.00 for Family Membership - if purchased by May 31, 2009
$85.00 for Family Membership - if purchased starting June 1, 2009
$40.00 for Individual Membership

FAMILY MEMBERSHIP - PARENTS & DEPENDENT CHILDREN - 18

Name

Age

Name

Age

MAKE CHECKS PAYABLE TO: PARKS AND RECREATION FUND

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

Mauch Chunk Lake Park reserves the right to revoke this membership application if any of the above information is found to be false. Admittance to the park on any day is on a first come first serve basis.
If purchasing by mail, please enclose a self-addressed stamped envelope-(postage is $.51).