First Coast Koi, Goldfish &

FIRST COAST KOI CLUB

MEMBERSHIP APPLICATION

Date______

Name 1) ______DOB Month ______Day______

Name 2) ______DOB Month ______Day______

Street Address ______

City/State/Zip ______Phone______

Cell 1) ______Email 1) ______

Cell 2) ______Email 2) ______

Would you object to your Name, Address, phone # or Email being listed in the club Directory? Yes ____ No ____

Do you have or plan to have a pond? ______Koi? ____ Goldfish? ____

Would you be interested in: Hosting a meeting? ______Serving on a committee? ______Showing your pond? ______Other? ______

Dues are $20 single or $25 for two people in same household

For more information please call one of the club officers listed on the website www.firstcoastkoiclub.com

Please make your check payable to: First Coast Koi Club

Mail to: Suzette Alexander 4554 Huntington Rd Jacksonville, FL 32210

THANK YOU AND WELCOME TO OUR CLUB All memberships are subject to Board approval