Association of Zoo and Aquarium Docents
Individual Membership Application

Name ____________________________________________________
First                              Middle        Last                                               

Address ___________________________________________________
Number (or Box #)        Street                                                            Apt #

City __________________ State _____ Zip __ __ __ __ __-__ __ __ __

Country ____________________

E-mail address ____________________________________________

Phone (_____)____________________     Years a Docent __________

Zoo/Aquarium Affiliation _________________________________________

Membership Category

[ ] Docent*	($15 U.S./year)
[ ] Inactive Docent*	($15 U.S./year)
[ ] Associate	($15 U.S./year)

[ ] New  [ ] Renewal                                Amount enclosed _______

Make checks payable to: Association of Zoo and Aquarium Docents (AZAD).

All funds payable through a U.S. bank.

Mail to: Kathy Schaeffer
2715 Weide Way
Lower Burrell PA 15068-3634

* A Docent shall be considered any volunteer who is involved in educating the public about zoos and aquariums.

AZAD refund policy: No refunds will be issued for amounts of $ 5 or less.  These funds will be considered a donation to AZAD. There will be a $ 10.00 Returned Check Charge.