MEMBERSHIP APPLICATION

Friends of Titusville Public Library

Please print and mail this form and your dues or donation to
Friends of Titusville Public Library
c/o Titusville Public Library
2121 South Hopkins Avenue
Titusville, FL 32780-4792

Please check the membership category you choose:

___ NEW __ RENEW

___ INDIVIDUAL ... $5.00       STUDENT ... $3.00

___ SPONSOR ... $25.00       ___ PATRON ... $50.00

___ ORGANIZATIONAL OR CORPORATE .......... $100.00 MINIMUM PER YEAR

___ INDIVIDUAL LIFE MEMBERSHIP .......... $200.00 ONE TIME

___ ORGANIZATION or CORPORATE LIFE MEMBERSHIP .......... $1000.00 ONE TIME


NAME _____________________________________PHONE _____________________

ADDRESS ________________________________________

CITY _____________________________ST ____ZIP___________

eMail ________________________________________

DATE __________________________



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