Wild Canid Survival and Research Center Application for Visit Form

    - Simply print this form, fill it out, and mail it back to us!
 

I'm interested in a:

 ___ Tour
 
 ___ Program/Tour

 


 NAME (Individual or Organization): _____________________________
 
 CONTACT PERSON for ORGANIZATION: _______________________________

 DAYTIME PHONE: _________________________________________________

 STREET ADDRESS: ________________________________________________

 CITY: _________________________ STATE: _________________________

 ZIP CODE: _____________________


Desired Date and Time:

 First Choice:  __________________________

 Second Choice: __________________________

 Third Choice:  __________________________


Number of:

 Adults:  _____________

 Children: ____________     ( Ages: ___________ )


Special Requirements or Requests:

 _________________________________________________________________

 _________________________________________________________________

 _________________________________________________________________

 

 Charge my:  ___ Mastercard  ___ Visa

     Account Number: _____________________________________________

     Expiration Date: ____________________________




     Signature: ______________________________________________  

     Date: _____________________________


** NOTE:  A $3 processing fee will be assessed on all charges.



    Mail this completed form to:

 Wild Canid Survival & Research Center
 Post Office Box 760
 Eureka, Missouri  63025


    If you need more information, please
feel free to call 636-938-5900 Monday through
Friday, 9am to 5pm. Or e-mail edu@wolfsanctuary.org

(internet group visit form. REV 08/2000)