Membership Application and Contact Information

Email Contacts: Jim Maiani Lynne Debo
Houghton Lake Trailblazers
P.O. Box 234
Houghton Lake, Michigan 48629
Date: ____/____/_____
Business: ____________________________
Name: ______________________________
First Name: __________________________
Last Name: __________________________
Spouse: _____________________________
Address: ____________________________
City: ________________________________
State: ______________ Zip Code: _________
Telephone: ___________________________
Email: ____________@_________________

Type of Membership Desired:
Family: $25.00
Business: $50.00 (please supply us with your card)
Single Person $15.00
New (  )

Renewal (  )

Please Return to:
Houghton Lake Trailblazers
P.O. Box 234
Houghton Lake, Ml 48629

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