Great East Lake Improvement Association (GELIA)
Membership Form
___New Member ___Renewal Date: ______________________
Primary Member - Last Name: _________________________, First Name: ___________________
Spouse or Other - Last Name: _________________________, First Name: ___________________
Address that serves as your primary residence (Where you vote)
# and Street: ________________________________________________________________________
City/Town: _______________________________________ State: ______ZIP+4:________________
Home Phone: ________________________________ Email: _________________________________
Your email and contact information will be kept only for GELIA business.
If you own property at Great East Lake, Please list the address (or "same" if same as above):
# and Street: _______________________________________________________________________
Town: ____________________________________________ State: ______ ZIP: ______________
Lake Phone: ________________________
Dues cover membership from July 1st through June 30th the following year.
GELIA is a 501(C)(3) Tax-Exempt organization and your contribution is tax deductible. Basic: $20Supporter: $50Sponsor: $75Benefactor: $100 $___________
____ I/we would like to help. Please contact me/us about volunteer opportunities with GELIA.
To become a member:Please print this form, include your check payable to:
GREAT EAST LAKE IMPROVEMENT ASSOCIATION and mail to:
GELIA, c/o Gary Field, PO Box 762, Tewksbury, MA 01876
