<p> FIRST COAST KOI CLUB</p><p>MEMBERSHIP APPLICATION</p><p>Date______</p><p>Name 1) ______DOB Month ______Day______</p><p>Name 2) ______DOB Month ______Day______</p><p>Street Address ______</p><p>City/State/Zip ______Phone______</p><p>Cell 1) ______Email 1) ______</p><p>Cell 2) ______Email 2) ______</p><p>Would you object to your Name, Address, phone # or Email being listed in the club Directory? Yes ____ No ____</p><p>Do you have or plan to have a pond? ______Koi? ____ Goldfish? ____</p><p>Would you be interested in: Hosting a meeting? ______Serving on a committee? ______Showing your pond? ______Other? ______</p><p>Dues are $20 single or $25 for two people in same household</p><p>For more information please call one of the club officers listed on the website www.firstcoastkoiclub.com</p><p>Please make your check payable to: First Coast Koi Club</p><p>Mail to: Suzette Alexander 4554 Huntington Rd Jacksonville, FL 32210</p><p>THANK YOU AND WELCOME TO OUR CLUB All memberships are subject to Board approval</p>