New               Renewal

Name
Street Address
City			State			Zip
Home Phone		Work Phone
FAX			Email

Names of family members to be included in membership: (Adults are 18 and over)

adult    child	adult    child
adult    child	adult    child

To help us with program planning, please check your interests:

Fish Ponds	Water Gardening	Koi	Aquatic Plants	Pond Maint.

Landscaping	Plant Propagation	LA Iris	Fountains/Statuary	Conservation	

Pond Tour	Pond Construction	Goldfish	Water Lilies/Lotus	Fish Breeding

Other:

Dues are $25.00 per calendar year per family.  Make checks payable to CAPWGS

Please print form & mail with your check to:
DEEP SOUTH KOI & POND SOCIETY P O Box 82484, Baton Rouge, LA 70884

After printing press the back key to return to the previous web page.