Please provide the following contact information:
Please Note: Items marked by a red "*" indicate required information to process this form.

*First name:
*Last name:
Organization:
*Address:
Address (cont.):
*City:
*State/Province:
*Zip/Postal code:
Country:
Phone:
FAX:
*E-mail:
URL:
Please List Family Members That Will be Sharing This Sponsorship.
Name:   Birth Date: Name:   Birth Date: Name:   Birth Date: Name:   Birth Date: Name:   Birth Date:
Each sponsor receives a laminated biography, a yearly membership, a birthday card, and their name listed on a sign posted on the sponsored animal's cage.
*I would like to sponsor a: ***Here's the Fun Part -- Pick Your Critter*** Bird at $250.00 per yr. or $25.00 per mo. Small mammal aat $500.00 per yr. or $50.00 per mo. Small cat or monkey at $750.00 per yr. or $75.00 per mo. Cougar at $1,000.00 per yr. or $100.00 per mo. Leopard at $1,500.00 per yr. or $150.00 per mo. Bear at $1,800.00 per yr. or $180.00 per mo. Lion or Tiger at $2,000.00 per yr. or $200.00 per mo. Please Contact Me *The payment plan I prefer is:  ***Pick a Payment Plan*** A Full Year - 1-time Payment Monthly Payments *Charge the above amount to my:  ***Select Your Credit Card*** MasterCard Visa Discover American Express *Name that appears on the credit card:  *Credit Card Number: *Expiration Date: (Month)  ?? 01 02 03 04 05 06 07 08 09 10 11 12    *(Year)  YEAR? 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010