form

Date___/_____/____

Name_____________________________

Address___________________________

City ______________________________

State_______________ Zip_________

Phone______________________

Email_______________________

*All new members will receive a year's subscription to Words from the Wild.

If you would like to become a member of Wildlife Works, are interested becoming an on-site volunteer, or have an in-kind donation, please let us know! Just complete the form, print, and send with your check or money order (when applicable) to Wildlife Works, Inc., PO Box 113, Youngwood, PA 15697.

Please check all that apply

__ The included check/money order is a general donation.

__ Please contact me to discuss the volunteer program.

__ Please contact me about in-kind donations.

__ I would like to Sponsor an Animal at $_______.
Animal:______________

__ Yes, I'd love to be a member of Wildlife Works as a/an...

       __ Individual ($15)

       __ Family ($25)

       __ Classroom ($25)

       __ Sponsor ($50)

       __ Patron ($200)

       __ Sustaining ($500)

       __ Lifetime ($1000)

Donations/Membership/Volunteer/
Animal Sponsorship/Contact Form

Thank you
for your tax-deductible contribution to Wildlife Works, Inc., a registered 501(c)3 non-profit.

Questions on this form? Please call 724-925-6862.