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Friends of the Topeka Zoo (FOTZ)
Membership Application

Complete this form, print and mail to:
FOTZ Membership
635 SW Gage Blvd.
Topeka, KS 66606.

ALL MEMBERSHIPS ARE NONREFUNDABLE
AND NONTRANSFERABLE

Type of membership:
Senior Citizen $25
Individual $35
Single Parent Family $45
Family $50
Special Friends $70
Zoo Buff $95
Super Zoo Buff $145
Baby-sitter option $15- This option is an additional fee that will be added to a Single Parent Family or higher membership fee.


Member Information:

Primary Adult -
First Name: Last Name:

Secondary Adult - (needed for Family and higher memberships)
First Name: Last Name:

Address:

City: State: ZIP:

Number of children/grandchildren, age 17 and under

Home Phone: Work Phone:  

Cell Phone:

E-mail:

I am purchasing the above membership as a gift (if so, please fill out the gift giver information below).


Gift Giver Information (if applicable):

Names:

Address:

City: State: ZIP:

Home Phone: Work Phone:

Cell Phone:  

E-mail:

Send membership cards to: Recipient Giver

Send renewal notice to: Recipient Giver

A gift card will be enclosed with each membership.

Payment:
Please make checks payable to Friends of the Topeka Zoo. Your cancelled check is your receipt.

Charge my: Visa Mastercard

Account #: Exp Date:

Verification code:
The verification code is the last three digits that appear in the signature panel on the back of your credit card.

Signature:______________________________________

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