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Membership Application
Name
*
First Name
Last Name
Additional member (if applicable)
First Name
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
*
Verify Email
*
Phone
Join our emailing list?
*
Yes
No
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Gift of Membership for
First Name
Last Name
Additional member if applicable
First Name
Last Name
Gift Recipient e-mail address
Verify Email
Gift Recipient Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
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