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 __________________________