Friends of the Selinsgrove Community Library Membership
application
Please print this web page form.
Mail to:
Friends of the Selinsgrove Community Library
P.O. Box 112
Selinsgrove, PA 17870
Yearly Dues for January to December 2009
| ______ Senior Citizen / Student - $5 | ______ Individual Membership - $10 |
| ______ Family Membership - $20 | ______ Corporate Membership - $100 |
| ______ Lifetime Membership - $200 | ______ Donation - $_____ |
PLEASE PRINT
Name ___________________________________________
Address _________________________________________
City ____________________________________________
State ______ Zip Code ______________
Phone number _____________________________ Email ___________________________________________
Please make your check payable to:
Friends of Selinsgrove Library
_____Call me about volunteering
_____ Call me for information on making a bequest to the Selinsgrove Community Library