Today's Date: ____________________

Name(Adults)_________________________________________

Address______________________________________________

City/State/Zip__________________________________________

Day/Eve Phone's_______________________________________

Email________________________________________________
 

Participant's Name	M/F	Age(kids)	Activity Title	Section/Dates/Time	Fee

Circle One:   Member         Non-member

TOTAL ENCLOSED $__________

________ Check enclosed

________ Charge to my ___Visa  ___MC  ___Discover  ___AMEX

Account #:___________________________________

Expiration Date: _______________________________

Signature:____________________________________
 

All program registrations must be received by mail, phone, or otherwise delivered to the Zoo. Program registrations will be prioritized by the postmark date, or date of receipt for those registrations phoned-in or delivered to the zoo. All programs are subject to cancellation if minimum enrollment requirements are not met. You may contact us with any questions at: (719)633-9925, ext. 127
Please return completed form with Payment. Checks should be made Payable to Cheyenne Mtn. Zoo.

CMZ Education Programs
4250 Cheyenne Mountain Zoo Rd.
Colorado Springs, CO 80906
Fax: (710)633-2254