Bulow Plantation Homeowners Association

Application for Membership and Information Form

Membership Dues: $20.00

(Last Name)

(First Name)

____________________________________________________________
(Spouse/Other Occupant)
(Lot #/Address)
Is one household member age 55 or older?

___Yes ___ No

What is your email address? _________________________________

I (we), the undersigned, being manufactured home owner(s) resident(s) in
Bulow Plantation, Flagler Beach, Flagler County, Florida, hereby consent to become
member(s) of the Bulow Plantation Homeowners Association, Inc., in accordance
with Sections 723.075 and 723.078, Florida Statutes.
I (we) further indicate that I (we) waive the right to receive notice of the
Annual Meeting by mail, per F.S. 723.078.
Applicant Signature ___________________________________________________

-~-~-~-~If You Do Not Live in Florida All Year

What is your alternate address? __________________________________
What is your telephone number there? (
Do you receive email there?

) ________________

_____ Yes _____ No

--------------------------------------(Tear here)------------------------------------------Received $20.00 for dues from ___________________________________

Received by _________________________________________________
Year(s) _____________________________________________________