Membership form

The Lupus Foundation (Wolf Sanctuary) ADOPTION FORM
Date:
Name & Surname:
Telephone number:
Postal Address:
Postal Code:
Email Address:
WOLF NAME:
Adoption Type:	PRIVATE		CORPORATE
Payment cycle:	MONTHLY		ANNUALLY
Method of Payment:	CASH	Debit Order	Electronic Payment
Please complete the above form and attach your proof of payment and fax it to 021 671 7909 or email info@wolfsa.org.za.
Our Bank details are as follows: The Lupus Foundation Bank: Nedbank Branch: Claremont Account type: Savings Account Number: 2046548558 Thank you for your support.
P.O.Box 44890, Claremont 7735 Erf 510, Witelsbos, Tsitsikamma Telephone: (H/Office) 0827746274