Individual Membership (1)

%AM, %06 %187 %2012 %03:%Jul

Individual or Family Membership

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Koi Society / American Koi Keeper LogoIndividual / Family Membership

Name:________________________________________________________

Address:______________________________________________________

City, State, Zipcode:_____________________________________________

Country (if other than USA):______________________________________

Email (which will also be your login):_______________________________

Phone #_______________________________________________________

I am a member of the following Koi Clubs:___________________________

______________________________________________________________

Signature:______________________________________________________
By signing this application, I verify that I am at least 18 years of age.

Each individual or family membership yearly dues is $25.00.  Initial membership will expire 12-

31-2013.

Lifetime Individual / Family Membership

Lifetime Individual / Family Memberships will be available for our most enthusiastic supporters.  

Lifetime Membership received by December 31, 2012, will be recognized on our website and will

receive one special collectible Koi Society Charter Lifetime Member pin.  Charter Lifetime Member

pins will be sponsored by Founding Trustee John Sprinkle.

Lifetime Individual or Family Membership dues is $250.00.

Send this application and check payable to Koi Society to:

Koi Society
Luanne Porter, Treasurer
PO Box 2020
LaBelle, FL  33975