Please fax or mail this form.  *Equals Required Field

Name:* ____________________________________

Organization/School
(if applicable): ____________________________________

Street Address:* ____________________________________

City:* ____________________________________

State:* ____________________________________

Zip Code:* ____________________________________

Daytime Phone: (______)______-_______________________

Evening Phone: (______)______-_______________________

Email:* ____________________________________

Animal to be Adopted
Animal Selected: ____________________________________


Gift Information
Make it a gift  [ Yes / No ] (Circle one)
Mail package to: [ You / Recipient ] (Circle one)

Gift Name:* ____________________________________

Street Address:* ____________________________________

City:* ____________________________________

State:* ____________________________________

Zip Code:* ____________________________________

Daytime Phone: (______)______-__________

Evening Phone: (______)______-__________


Giving Level
__ Individual Adoption $40
__ Club Adoption $100
__ Group Adoption $500
__ Zoo Keeper $1000
__ Additional Certificates with Photo $10

Total Due: ____________

Payment Information Note: This is not an SSL secure form.

Payment Type (circle one):   VISA   MASTERCARD   AMERICAN EXPRESS   DISCOVER

Name on card: ____________________________________

Card Number: ____________________________________

Expiration Date: _____/_________ 

Please fax this form to (248) 541-0344 or mail to:

Detroit Zoological Society
8450 W. 10 Mile Road
Royal Oak, MI 48067