PACIFIC NORTHWEST KOI CLUBS ASSOCIATION
CLUB & OFFICER UPDATE

Club Name: _________________________________________________________
Web site: ____________________
Club Contact: _______________________________________________________
Address: *__________________________________________________________
Street/PO Box City state/province zip/postal code
Tele: ____________ Best time to call:______ Email:_________________________
*Please use the club’s permanent address or the best address to mail club information.
Representative (1): ___________________________________________________
Address: ___________________________________________________________
Street/PO Box City state/province zip/postal code
Tele: ____________ Best time to call:______ Email:________________________
Representative (2): ____________________________________________________ 
Address:____________________________________________________________
Street/PO Box City state/province zip/postal code
Tele: ____________ Best time to call:______ Email:________________________
President/Chief Executive:_____________________________________________
Address: ___________________________________________________________
Street/PO Box City state/province zip/postal code
Tele: ____________ Best time to call:______ Email:________________________
Vice-President:_______________________________________________________
Address: ___________________________________________________________
Street/PO Box City state/province zip/postal code
Tele: ____________ Best time to call:______ Email:________________________
Secretary: ___________________________________________________________
Address: ___________________________________________________________
Street/PO Box City state/province zip/postal code
Tele: ____________ Best time to call:______ Email:________________________
Treasurer:____________________________________________
Address: ___________________________________________________________
Street/PO Box City state/province zip/postal code
Tele: ____________ Best time to call:______ Email:________________________
Newsletter Editor_____________________________________________________
Address: ___________________________________________________________
Street/PO Box City state/province zip/postal code
Tele: ____________ Best time to call:______ Email:_________________________
AKCA Rep:__________________________________________________________
Address: ___________________________________________________________
Street/PO Box City state/province zip/postal code
Tele: ____________ Best time to call:______ Email:________________________

Submitted by: _____________________________ date: _____________________
Mail your list or this completed form to: DianaLynn Rehn, PNKCA Secretary, Email: drehn@workwith.com
Please include email addresses!