Membership Form

As a Member of the Friends of the Antioch Library, you will receive newsletters giving advance notice of library events.

Name

____________________________________________________________

Street Address

____________________________________________________________

____________________________________________________________

City/State/Zip code

____________________________________________________________

Phone

____________________________________________________________

Email

____________________________________________________________

(   ) New     (   ) Renewal

 

Type of Membership:

(   ) Individual ($10.00 / year)
(   ) Family ($15.00 / year)
(   ) Senior ($5.00 / year)
(   ) Additional Gift: $________
(   ) Lifetime (Corporate, Family, Single, or Senior) ($100.00 / lifetime)

Are you able to help with ... ?

(   ) Sales

Please send this form along with your check or money order for your dues to: