Name:
Address:
City:				State:		ZIP:
___	$15	 Individual membership
___	$30	 Family membership
___	$50	 Donor
___	$100	 Patron
___	$250-499 President Club
___	$500	 Lifetime membership
___	$	 Not interested in membership but here is my donation.

make checks payable to:
Springfield Zoological Society

Mail to:
Springfield Zoological Society
P. O. Box 20406
Springfield, IL 62708