New Family Membership Account

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Member Information

Member Name *

First

Last

Additional Family Member (First Last) #1

Enter family member names. All family members must reside under same address.

Additional Family Member (First Last) #2

Enter family member names. All family members must reside under same address.

Additional Family Member (First Last) #3

Enter family member names. All family members must reside under same address.

Additional Family Member (First Last) #4

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Phone *

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Address *

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Zip Code

Date of Birth *

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Member Membership Total

Number of Freshwater Tanks

How many Freshwater Aquariums do you currently have and/or maintain?

Please list special interests if any

Share your special interests with us. Example, fish breeding, keeping seahorses, planted tanks, etc.

Number of Saltwater Tanks

How many Marine Aquariums do you currently have and/or maintain?

How did you find out about The Brooklyn Aquarium Society?

Please tell us how you first heard of us.

Waiver and Term Selection

Liability Waiver *

• I/We release The Brooklyn Aquarium Society and its board members of all and any liability and responsibility.

Select Membership Term - 1 to 5 Years [Click To Select]Family Member - 1 Year - $25.00Family Member - 2 Years - $45.00Family Member - 3 Years - $63.00Family Member - 4 Years - $85.00Family Member - 5 Years - $100.00

Select membership terms longer than 1 year for additional discount.

Total Amount

$0.00

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Card Number

Expiration Date

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Total

$0.00

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