MISSOURI AQUARIUM SOCIETY FORM FOR MEMBERSHIP OR RENEWAL

Membership is $15 per calendar year and includes a subscription to the club electronic publication “The Darter”.

After June 30, membership for the remaining part of the year is $10.

Membership includes everyone in the immediate household.

 

NAME:__________________________________________________________

 ADDRESS:_________________________________________________________

 CITY:_______________________________   STATE:_____________________

 ZIP CODE:______________________________

 EMAIL:_____________________________________We must have to mail your Darter to you.

(optional) PHONE NUMBER:_____________________________________

 

1.     May we publish this address in The Darter once a year as part of our membership roster? YES/NO (circle one)

2.     May we publish your email address?  YES/NO (circle one)

3.     May we publish your phone number?  YES/NO (circle one) 

Please print, fill out this form and mail this form and your check to:

Ron Huck
6301 Kingsway Drive
Affton, MO
63123-1525

Dec. 2015, Kathy Deutsch