Affiliated Club Membership
Name of Club:_______________________________________________________
City, State, Zipcode:___________________________________________________
Country (if other than USA):____________________________________________
Club Web Manager contact:_____________________________________________
Web Manager’s email:_________________________________________________
The Affiliated Club is responsible for submitting membership information and email addresses for
its members who wish to be members of the Koi Society. Initial membership will expire 12-31-
Clubs submitting payment received by October 31, 2012, will be recognized as Charter Affiliated
Clubs and will be recognized on our website.
Dues for Clubs with 100 or less memberships is $100.00.
Dues for Clubs with 100 or more memberships, please complete Club Membership application and
submit to our Officer and Board of Trustees for review and dues structure.
Send this application, club member information (on disc or by email) and check payable to Koi
Luanne Porter, Treasurer
PO Box 2020
LaBelle, FL 33975