Louisiana Purchase Zoological Society Membership Application

Louisiana Purchase Zoological Society Membership Application
YesNo
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*
YesNo
Type of Membership

LPZS Memberships*

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

$0.00

Date

MonthDayYear
Date
Membership Rewards
YesNo
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
MY ADDRESS - Please mail my card/s to my address listed aboveRECIPIENT ADDRESS - Please mail the card/s to the recipient address listed abovePICK 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
Should be Empty: