Clone of Membership Application form only

North Florida Koi Club Membership Application

All information is held strictest confidence. At no given point is information disclosed or shared without client’s written consent. You may choose to skip answering any question you feel impinges on personal information you do not wish to disclose.

Full Name*

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Full Name

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Jr. League Member: Under age 18

Full Name

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Phone Number*

E-mail*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Would you object to your Name, Address, Phone or E-Mail being listed in the club Directory?

YesNo

Do you presently own koi ?

YesNo

Do you presently have a pond?

YesNo

Do you have aquarium?

YesNo

Would you be interested in any of the following? (Check all that apply Below)

Hosting a meetingshowing your pondbeing on a committeeShowing your fish

Would you like the club to assign an experienced koi keeper to serve as you’re a mentor?

YesNo

Member Benefit 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.

2023 North Florida Koi Club Annual Membership Dues

2022 dues were waived due to COVID/social distancing. We are up and running looking towards koi fellowship. Dues are:

$20 single person, $30 per couple, Junior member $5 (18 and under).

Make check payable to: North Florida Koi Club.

Mail payment to:

Treasurer, Suzette Alexander – 4554 Huntington Road Jacksonville, FL. 32210

Please submit your payment by February 28, 2023. If any inquiry regarding this reminder, contact us through our official website/Treasurer.

Date*

MonthDayYear

Signature*

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