Louisiana Purchase Zoological Society Membership Application
Are you giving this as a gift?
*
Yes
No
Recipient Name
First Name
Last Name
Recipient Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Recipient Phone Number
Please enter a valid phone number.
Recipient Email
example@example.com
Your Name
*
First Name
Last Name
Your Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Phone Number
*
Please enter a valid phone number.
Email
example@example.com
First Adult Name on the Card
*
Second Adult Name on the Card
*
Are You a Volunteer?
*
Yes
No
Type of Membership
My Products
*
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Family
2 Adults + Up to 4 Children (under 18)
$
100.00
Quantity
1
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Grandparent
2 Grandparents + Up to 5 Grandchildren (under 18)
$
80.00
Quantity
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Individual
One Person
$
45.00
Quantity
1
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10
Sustaining
Family Membership + 2 Guests
$
125.00
Quantity
1
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Credit Card
Membership Rewards
Are you in the Military or a First Responder?
*
Yes
No
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?
*
MY ADDRESS - Please mail my card/s to my address listed above
RECIPIENT ADDRESS - Please mail the card/s to the recipient address listed above
PICK UP - I will pick up my card/s at the Zoo Gift Shop during Monroe Zoo hours
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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