Individual / Family Membership
City, State, Zipcode:_____________________________________________
Country (if other than USA):______________________________________
Email (which will also be your login):_______________________________
I am a member of the following Koi Clubs:___________________________
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-
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:
Luanne Porter, Treasurer
PO Box 2020
LaBelle, FL 33975