Membership Application
Tampa Bay Koi and Water Garden Club
Date: ______________
Name: _____________________________________
Spouses Name: _____________________________
Address: ___________________________________
City: ___________________State: _________Zip Code: ________
Phone, Home: ______________ Business: ______________
Email: _________________________________
Type Membership
(Circle One): Family $25.00 Single $20.00Make Check Payable to: Tampa Bay Koi and Water Garden Club
Mail To: Tampa Bay Koi and Water Garden Club
12509 Worchester Ave.
Tampa, FL 33624
Do you currently have a pond? (Circle One) Yes No
Do you have koi? (Circle One) Yes No
Do you have goldfish? (Circle One) Yes No