Louisiana Purchase Zoological Society Membership Application

Louisiana Purchase Zoological Society Membership Application
Are you giving this as a gift?
Recipient Name

First NameLast Name
Recipient Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Recipient Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Recipient Email
example@example.com
Your Name

First NameLast Name
Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
First Adult Name on the Card
Second Adult Name on the Card
Are You a Volunteer?
Type of Membership

Family

2 Adults + Up to 4 Children (under 18 )

$100.00 Quantity

Grandparent

2 Grandparents + Up to 5 Grandchildren (under 18)

$80.00 Quantity

Individual

One Person

$45.00 Quantity

Sustaining

Family Membership + 2 Guests

$125.00 Quantity

Total

Date

MonthDayYear
Date
Membership Rewards
Are you in the Military or a First Responder?
15% Off for Military and First Responders
Military ID #
- 10% Off Birthday Parties
- 10% Off Purchases at The Wildside Gift Shop
- Unlimited Access to the LA Purchase Gardens and Zoo
- Free Admission to Special Events
- Memberships are valid for one year from date of purchase
Membership Card Pick-up Or Delivery
How would you like to receive your membership cards?
Interested in becoming more involved with the Zoo? Please leave your email here if you are interested in being an LPZS Board Member!
example@example.com
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