OREGON KOI & WATERGARDEN SOCIETY

APPLICATION

Name(s):_________________________ Date:_________

Address:_____________________________

City:______________State:___ Zip:_______

Phone: ______________________________

Fax: ________________________________

e-mail: ______________________________

Business Name:_______________________

Do you have Koi and/or Watergarden pond?

Watergarden?________How Long?_______

Koi Pond?__________How long?________

What size?____________No. Gals?_______

Type of Filter?_________No. of fish?_____

Hobby?_____Show Koi?_____Both:______

Number of years experience?____________

What would you like to do, see, or learn from the club?

_______________________________________________

_______________________________________________

_______________________________________________

Membership is $24.00 a year. $2.00 a month

(# of months remaining

till June X $2.00) = $_________

Name Tag, $7.00 each (optional)$___________

Club Jacket $70.00 (optional) $_________

Size____________

Check # :______ Total Paid $_________

Date:________

For more information call

Norman Call at 541-496-3403 or

MAIL APPLICATION and CHECK to:

OK&WS TREASURER

Robin Lugar

PO BOX 1352 • Roseburg, OR 97470