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| We offer a Koi Rescue Service. |
North Fl. Koi Club Membership Application 2009 Application Date:______________________ New ___ Renewal___ First Joined NFKC____(yr) Single__ ($20) Double___($30) Junior___($5) Total Dues $_________ Payment by Cash__ Check__ (if check) Check #_____________ Date Pd._______ Name:________________________________________________________ DOB Month___ Day___ Name:________________________________________________________ DOB Month____Day___ Jr. Member (under 18) Name _______________________________________ DOB Month__Day___ Address:____________________________________________________________________________ City/State/Zip________________________________________________________________________ Home Phone:_(____) _________________ Cell Phone_________________________ E-Mail _______________________________________________ Would you object to your Name, Address, Phone or E-Mail being listed in the club Directory? Yes___ No__ Do you presently own koi? ___ , Do you presently have a pond? ____ Are you interested in plants? _________ Would you be interested in any of the following? ( Check all that apply) Hosting a meeting ____, Being on a committee____, Showing your pond ____, Showing your fish ____ Would you like the club to assign an experienced koi keeper to serve as your a mentor? Yes___No ___ Are you a subscriber to KOI USA?_________________ Member Benifit Listing: The club will be publishing a listing of members, member businesses, skills and specialized knowledge to give members a reference when making purchase or needing advice and for the purpose of finding your personal interests in the hobby and specialty skills. Do you have specialized knowledge of subjects such as koi health, breeding, plants, chemicals, filters, pond building, electrical, plumbing, concrete or any other area which you feel would be of interest.
_________________________________________________________________________________________________ Dues: $20.00 Single Membership, $30.00 Double Membership, Jr. League $5.00 each member Dues are payable January 1st - Please use this form so that we can update your information Mail checks made payable to North Florida Koi Club or NFKC: Vickie Leonard, 4651 Blount Ave, Jax. Fl. 32210
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