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Membership Application

Name *

First Name

Last Name

Additional Member (if applicable)

Enter First and Last Name

Library

Please complete for library memberships only

Transaction Type *

New Membership

Renewing Membership

Gift Membership

Membership Level *

$75 - Individual Membership

$100 - Family/Household

$150 - Contributing

$250 - Benefactor

$500 - Sponsor

$1,000 - Patron

$150 - Library

Email *

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Phone

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Phone Type

Home

Cell

Address *

Address Line 1

Address Line 2

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City

State

State/Province

ZIP/Postal Code

Country

Gift of Membership for

First Name

Last Name

Gift Recipient e-mail address

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Gift Recipient Address

Address Line 1

Address Line 2

City

City

State

State/Province

ZIP/Postal Code

Country

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