St. Francis Wildlife Association
Community Conservation Partnership Program
Application Form

Please print, complete and mail to address at bottom of page.

Business Name __________________________________________________________________

Contact Person ______________________________________ Position__________________________

_________________________________________________________

_________________________________________________________
Address

____________________________
Date

 __________________________________
Phone		  _______________________________________
FAX
 __________________________________
E-mail		  _______________________________________
Web Site

Please check Level of Participation:

 ______ 1. Kestrel Level: $200

______ 2. Screech Owl Level: $300

______ 3. Barn Owl Level: $400

______ 4. Barred Owl Level: $600

______ 5. White-tailed Deer: $800

______ 6. Red-tailed Hawk Level: $1,000

______ 7. Great-horned Owl Level : $2,000

______ 8. Bobcat Level: $3,000

______ 9: River Otter Level: $4,000

______ 10. Bald Eagle Level: $5,000

 

In lieu of part or all of the requested donation, I will provide the following in-kind goods or services:

 

____________________________________________________________________________________________

Your business will be included on our WILD CARD premium, which offers discounts on goods and services at local businesses to members who join St. Francis Wildlife at the $50 level or higher.

Please describe your discount or special offer that you would like to be listed with the WILD CARD:

 

___________________________________________________________________________________________

Important:
* With your completed form, please include or e-mail as a JPG attachment, an ad, approximately 2" X 3" for your business that will appear in our newsletter. A business card with a white or ivory background is also suitable.

Please contact Barbara Barnett Sullivan, Community Conservation Partnerships Coordinator, to discuss in-kind donations or to schedule wildlife displays or programs .

Please send this completed form and your check to:

Barbara Barnett Sullivan
Community Conservation Partnerships
St. Francis Wildlife Association
P.O. Box 38160
Tallahassee, FL 32315

St. Francis is a 501C-3 non-profit organization. All donations are tax-deductible.

A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROMTHE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800.435.7352) WITHIN THE STATE.REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THE STATE.
St. Francis of Assisi Wildlife Association, Inc. Registration #: CH4537

Community Conservation Partnership program

 St. Francis Wildlife Association