PLEASE PRINT THIS FORM AND SEND IT
Andre's Aquarium Club Membership Form:
MEMBERSHIP COSTS (US$) :
$9.95, Three months
$29.95 one year
$49.95 Lifetime/no annual fee,
MAIL TO: William D. Richmond, 290 Scottsdale Rd., Pleasant Hill, CA 94523
Enclosed is a check or money order made out to William D. Richmond in the amount of $___________(US$).
This is a (please check one): new membership _____ renewal _____.
Mrs. / Ms. / Mr. / Dr. ________________________________PHONE______________________
Please Print:
ADDRESS_____________________________________________________________________
CITY____________________________________STATE/PROV._________________________
ZIP CODE____________________COUNTRY (if not USA)_______________________________
E-MAIL ADDRESS _________________________________________
Please tell us how you heard about us: ____________________________________________________
Which of the following best describes your involvement with fishes?
[ ] Aquarium hobbyist
{ } Freshwater........ or Saltwater..........
[ ] Professional aquarist (lab or public aquarium)
[ ] Commercial fish breeder
[ ] Pet professional
[ ] Fisheries professional
[ ] Research (university, resource agency, consulting firm, etc.)
[ ] Education ( elementary, high school, collage)
[ ] Environmental or conservation activism
[ ] Other:
Which of the following activities do you participate in? (check all that apply)
[ ] Keep exotic fishes in home aquaria
[ ] Maintain an outdoor pond
[ ] Breed exotic fishes
[ ] Collect fishes from the wild
[ ] Observe fishes in the wild
[ ] Scientific research on exotic fishes
[ ] Volunteer for environmental organizations
[ ] Other:
To return to benefit page