Rolling Hills Zoo Online Membership Form

Rolling Hills Zoo Online Membership Form
Note: Upon clicking "Submit," you'll receive an email confirmation. Your email confirmation should arrive within the next 30 minutes.

If you do not receive a confirmation email, or receive an error, please contact us at 785-827-9488 ext. 116 (Kathy Tolbert) or email kathy@rollinghillszoo.org so we can confirm and/or complete your registration.
Are you purchasing this Membership as a Gift?*

YesNo
Your (Purchaser) Name*

First NameLast Name
Your (Purchaser) Mailing Address*

Mailing Address

Mailing Address Line 2

CityState / Province

Postal / Zip Code
Your email address. (If this is a gift, we will email you a confirmation though this email.)*
example@example.com
Is this a New or Renewal Membership?*

NewRenewal
What is the Member #:
Membership Information

This is the information associated with the membership. If this is a gift, you would put the gift recipient's info here.
Name*

First NameLast Name
Address*

Mailing Address

Address Line 2

CityState

Zip Code
Phone Number*
Email*
example@example.com
Second Card Holder's Name: (Does Not Apply to Individual Membership)

First NameLast Name
If this is a Family Membership, list the Names and Ages of Children. (If not, skip)
Example: Tom - Age 4, Chelsea - Age 8
Would you like to mail this gift membership to the address of the person(s) you are gifting this to?

Yes, please mail it to them.No, mail it to me, please.
Additional Information or Comments:
Please verify that you are human*
Membership Levels*
prevnext( X )
Individual Membership
$45.00



Individual +1 Membership
$90.00



Couple +2 Membership
$145.00



Family Membership
$145.00



Family Plus Membership
$175.00



Supporter Membership
$300.00



Caregiver Membership
$500.00



Total

$0.00

Pay with Credit Card

Should be Empty: