Name *

First Name

Last Name

Spouse Name (if applicable)

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Mobile Phone

(###)

###

####

Cottage Phone

(###)

###

####

Cottage/Marina Township *

In which township is your lake property located?

Drummond North Elmsley

Rideau Lakes

Tay Valley

Membership Type *

Cottager

Boater

Local Resident

Membership List Posting *

Do you agree to have your name included, with no other identifying information, on the BRLA Membership List, posted on the Members' Section page of the website?

Yes

No

Volunteering *

We are always looking for new people to engage in our community. Are you interested in becoming involved?

Yes, please contact me about volunteering

No