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FRIENDS OF THE FREEPORT MEMORIAL LIBRARY
MEMBERSHIP APPLICATION
Your membership is tax deductible to the extent that the law allows.
Please Print:
Please check Annual Membership Level: Individual $15 ______ Additional Contribution: ______________
Benefactor $50 _____ Corporate Matching Gift: ______________
Title (please circle): Dr. Mr. Mrs. Ms. Other________________________
First Name: ___________________________________________ Last Name: ____________________________________________
(If corporate membership) Business Name:________________________________________________________________________
Street Address: _________________________________________ Town: ___________________ State: _______ Zip:____________
Phone: _______________________________________ E-mail: ___________________________________________________________
I would like to be an ACTIVE ______ or INACTIVE _______ member.