Name________________________________________________________________________________

     Address__________________________________City__________________State______Zip__________

     Phone Number________________________E-Mail Address_____________________________________

     PAYMENT INFORMATION

     Please make check payable to the Racine Zoo and bring it to the Racine Zoo or mail it in an envelope with

     this form to

     Racine Zoo

     200 Goold Street

     Racine, WI 53402

     Or Charge (check one): _____VISA  _____MC  _____Discover

     Credit Card Number:_______________________________________________Expiration Date__________

     Signature:_______________________________________________________________________________

     MEMBERSHIP CATEGORY: Please circle one

     ____Director $5,000         ____Curator $2,500         ____Conservationist $1,000         ____Naturalist $500

     Call 262-636-9189 if you have any questions or are interested in learning about other levels of membership. 

     A letter outlining all of the membership benefits will be mailed to you within ten business days of receipt.

     Thank you!