Please fill out this form clearly and completely and mail, along with payment, to:
Provincial Wildlife Park PO Box 299, Shubenacadie Nova Scotia, Canada, B0N 2H0
Name
Address
City
Province
Postal Code
Country
Phone
Email
Animal to be sponsored
Sponsorship Amount
$
Name(s) to appear on Certificate:
Thank-you package to be forwarded to: Name and Address Listed Above Name and Address Listed Below
Preferred T-Shirt Color (for sponsorships of $50 and above): Red Light Blue Sand Indigo Light Green Pink Tangerine
T-Shirt size: Small Medium Large Extra Large
Payment Enclosed:
Check Money Order
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