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Membership Application

The Friends of the Independence Public Library

Name: __________________________________________________________________________

Address: ________________________________________________________________________

City: _____________________________________________ State: ________________________

Phone: ________________________                              Other Phone: _______________________

E-Mail: _____________________________________________   

New Member: _______         Renew Membership: _______

Annual Memberships:

_____ Children / $5.00               _____ Individual / $10.00                _____ Family / $25.00

_____ Patron / $50.00                  _____ Lifetime / $1,000.00        

 

We need volunteers to help make refreshments, help with fund-raising, help organize volunteers, help with programs, and help with annual book sale.

I would like to help:

Refreshment Committee  _____

Advertising Committee    _____

Decoration Committee     _____

Program Committee          _____

Anything Needed              _____

 

Please print this form and mail along with your Tax Deductible check to:

Friends of the Library
220 E. Maple St.
Independence, KS  67301

Thank You!