To register for LPZ programs, print this form, fill it out and fax or mail as per instruction on the Calendar Page.

Registration Information

Participant's Name___________________________________________________

Parent/Guardian Name 
(if participant is under 18)___________________Relationship__________

Address______________________________________________________________

City/State/Zip_______________________________________________________

Day Phone / Evening Phone____________________________________________

Membership Number (required for members' rates)______________________

Payment Method

CHECK payable to: Lincoln Park Zoo 

CREDIT CARD: (circle one)   VISA   MasterCard   AmEx   Discover

Acct. No._________________________________________Exp. Date__________
 
Signature____________________________________________________________

Billing Address (if different from mailing address):



Program Information
(please specify Section A or B if appropriate)

Program Title_______________________________________________________

Section____2nd choice_________________________________________________

# of adults______# of children_____children's ages____________________

ticket #___________________________Program Fee  $_____________________

Program Title_______________________________________________________

Section____2nd choice_________________________________________________

# of adults______# of children_____children's ages____________________

ticket #___________________________Program Fee  $_____________________


________Sign us up for a Lincoln Park Zoo Household Membership! ($45)	

                                         Total  $_________________