| Date |
|
| Type
of Membership: |
Family (all under one roof) $35.00 |
|
Single (single adult) $25.00 |
|
Corresponding (publication only) $20.00 |
| |
Junior (16yr or younger) $15.00 |
| |
Life $250.00 |
| Name |
|
DOB |
|
| Address |
|
| City |
|
| State |
|
Zip |
|
| Country |
|
| Phone |
|
| Email
Address |
|
| If
Family Membership, please list Spouse / Children |
|
| How
long have you been in the hobby? |
|
| How
many tanks do you have set up? |
|
| Do
you belong to other clubs? |
|
| What
kinds of fish do you have? |
|
| How
did you hear about NJAS? |
|
|
| Membership
Fees |
|
| Make
Checks Payable to: |
North
Jersey Aquarium Society |
| Return
with payment to: |
NJAS
Membership
PO Box 591
Nutley, NJ 07110 |