MEMBERSHIP APPLICATION

Name: ______________________________________

Address:_____________________________________

_____________________________________

Phone: ______________________________________

Email: ______________________________________

Birthday: Monday _________ Day __________

Year joined the Friends: ________________

Membership Dues:

• Individual $5.00/year
• Family $7.50/year
• Organization $50.00/year
• Contributing $100.00/year
• Life $500.00
• Student $2.00

Please print, complete and mail, along with dues, to:

Friends of the Library, Northwest Branch

5680 State Road PP

High Ridge, MO 63049