Lummi Island Scenic Estates Community Club
1211 Island Dr. • Lummi Island, WA 98262
Phone: (360) 758-2699 • e-mail: business@lisecc.com

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If you need additional help or would like to send a message please use our interactive Form. You may also request forms be mailed to you for 
Marina Use Decal, Club House Reservations or Surrogate Members Form
If you can not print a copy from the links above.

(use tab key or the mouse to go between fields) 

Your Name: 

Please make sure we are mailing to your home address if it is different than your Lummi Island address please fill in 
both parts of the form completely.

Address 1 ( your Home or Mailing Address):

City:

ZIP/Postal Code:

State or Province: 

Country:

Phone: 

FAX: 

Address 2 ( your Lummi Island Address if it different from the above):

City:

ZIP/Postal Code:

State : 

Phone: 

FAX: 

e-mail address: 

If you need a form please selected the the ones you need. 
if you are requesting other services or assistance 
please send a detailed message. 

Marina Use Decal
Club House Reservations
Surrogate Members Form
Water Service Request

If you wish to submit something for Our Members Page you may send in text on this form or e-mail us at business@lisecc.com. You may also attach a word document, a tiff or jpeg formatted image at 72 dpi to your e-mail. If you need more information on how to do this contact business@lisecc.com.

Please Include the starting and closing dates of any event! 
You would like listed

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Please be aware that Lummi Island Scenic Estates Community Club Reserves The right to edit all submissions for offensive or objectionable materials

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