Blount County Friends of the Library
MEMBERSHIP or DONATION FORM

Please provide the following contact information: (* required)

Preferred Title   (Select One)         Dr.   Mr.  Mrs.  Ms.  Mr. and Mrs. 
First Name * Last Name*
If desired, enter Second Name.    Title for Second Name: Dr.   Mr.  Mrs.  Ms.
2nd First Name 2nd Last Name
Mailing Address* State* 
City* Zip Code* + 4
Home Phone E-mail*   
Check here if you would like to receive renewal notices and other communications via e-mail.
Membership Group
      (Select One)		 Student Membership $10.00 per year
Individual Membership $12.00 per year
Family Membership $17.00 per year
Membership Type
(Select One) 		  New Membership Renewing Membership
Donation  (Optional) $  Check Number
 
Volunteer Interests
 I / We are interested in volunteering as follows:
(1) Whatever is needed (2) Used Book Sale
(3) Newsletter (4) Public Relations
(5) Refreshments (6) Helping in the Coffee Shop
 
Other
Interests

Enter today's date -- mm/dd/yy