Membership Application

Please send complete form & check
payable in U.S.dollars to:
APWE Membership, PO BOX 2771,
Carlsbad, CA 92008

APWE was founded to foster communication,
professionalism, and cooperation among those
individuals who work with captive wildlife in
educational programs for the public.

(Please print)
Full name:
Facility affiliation:
Title:
Street address:
City, State, Zipcode:
Phone number:
Email address:

(Check one)
Membership Status	Description	Annual Dues
Organization	Subject to Board Approval	$100
Professional	Salaried Wildlife Educator	$35
Associate	Salaried Wildlife Keeper	$25
Affiliate	Interested Party	$25
Student	Full-time Student	$20

Have you ever been convicted, in a court of law, for the mishandling or mistreatment of either children or animals? Yes_____ No______

If so, please explain: ______________________________________________________
_______________________________________________________________________

I do hereby swear, that the information I have provided, is both truthful and not misleading.

I am interested in serving on the APWE board or future committees .

I understand that APWE is a 501(c)3 organization and would like to donate $__________.

Signature:__________________________________ Date:______________________