Adopt a Red Wolf Application

Please print and complete this form, then bring or mail it to CNC at the above address.

Name_____________________________________________________________________

Address___________________________________________________________________

City_______________________________ State___________  Zip___________________

Phone_____________________________________________________

E-Mail_____________________________________________________

Amount of Payment__________________________________________

Method of Payment:

_____  Check (payable to CNC)

_____  Charge to Visa or Mastercard (please circle one)

Account #_______________________________ Exp. Date ______ /______

Signature_______________________________________________________

For more information, call Tish Gailmard (Wildlife Curator) at 423-821-1160 ext. 103