Ellijay Wildlife Rehabilitation Sanctuary
435 Cougar Lane
Ellijay, Georgia 30540
(706) 276-2980

Animal Adoption Form
Please print this page and mail it to the address above! Thank you.

Name:_______________________________

Address: ________________________________

City: _________________________ State: _________________  Zip:_______

I wish to adopt the following animal(s): _________________________________

I wish to participate in the following adoption level:

Bronze___ Silver___ Gold___ Platinum___ Life Saver___

Bronze Formal adoption papers in your name Your animal’s personal history A 2 x 4 ” picture of your animal Complimentary subscription to the Sanctuary’s newsletter	Silver All of the Bronze,  plus: A 1-year membership to the sanctuary (includes membership discounts on tours, camping and gift shop, and five free family days each year).	Gold All of the Bronze and Silver, plus: An 8 x 10” picture of your animal
Platinum All of the Bronze, Silver and Gold, plus: A five year membership to the sanctuary	Life Saver All of the Bronze through Platinum, plus:   A lifetime membership to the sanctuary

Please accept my one-time donation of: $_____________  
OR
Please accept my annual donation of: $_____________

Payment Method:  Check  __ Credit Card __
Master Card __ Visa __
Account Number : ______________Exp. Date: _______

Signature:  ________________________________