Regina Aquarium Society

Membership Application

Members Name:_____________________________________________

[ ] Junior Membership $10.00/year

(17 years and under)

[ ] Adult Membership $20.00/year

[ ] Family Membership $25.00/year

[ ] Correspondence $15.00/year

Name:_____________________________________________________

Address:___________________________________________________

__________________________________________________________

Postal Code:________________________________________________

Phone:_____________________________________________________

e-mail address:_______________________________________________

Method of payment

Cash

Check

Please return this application with your enclosed cheque to:

Regina Aquarium Society

P.O. Box 3654

Regina, Saskatchewan

S4P 3N8