Please Circle Renewal New Member
Name: _____________________________________________________
Address: ____________________________________________________
__________________________________________________________
Home Phone #: ( ) Cell Phone #: ( )
E-mail Address: ______________________________________________
New members tell us about yourself & your pond (optional) __________________________________________________________________________________________________________________________
Are you a koi related professional? Yes ( ) No ( ) What are your expectations from this koi club? How can we help you? _______________________________________________________________________________________________________________________________________________________________________________________
How long have you been keeping koi? _______________________________
How many gallons is your pond? ____________________________________
Liner type: _______ Concrete: _______ Other: _______
How many koi do you have? ___________
Please describe your pond’s filtration, pump etc: _______________________________________________________________________________________________________________________________________________________________________________________
Payment: $125
Check payable to: Tristate ZNA Koi Club.
Send this application and check to:
Tri-State ZNA Koi Club
c/o Laurie Kranglewitz
25 Pickwick Drive
Old Bethpage, NY 11804
Membership Form 2024 (pdf)
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