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* Fill in all the application information completely

PLEASE PRINT CLEARLY!

* Be sure your e-mail address is accurate and clear, we must be able to send you your passwords.

*Make your check or money order payable to : William Richmond

William is our Treasurer,

*PUT THE ENTIRE PAGE COMPLETLY FILLED OUT,  IN AN ENVELOPE with postage stamp attached.

* Mail the entire application and membership fee to:

William Richmond,

290 Scottsdale Rd.

Pleasant Hill, Ca. 94523

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Your Full Name :_________________________________________

Mailing Address:_________________________________________

City:__________________________________________________

State:____________ Zip Code:_________________ Country:_____________

E-MAIL Address:______________________________________________________________________________

( example: username@aol.com , This must be clear and exact )

Membership ( check one  X )

____3 month Membership ($9.95)

____1 Year Membership ($29.95)

____Lifetime Membership ($49.95)

Andre's AQUARIUM CLUB

Information Page