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Name: Please print clearly

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Mailing address

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City and State

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Zip + 4

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Area code and Telephone number

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Email Address

I wish to become an:
• Active Member (check area below)
• Supportive Member (contribution only)

I am interested in helping with:
• Home book delivery to shut-ins & elderly
• Short term special projects
• Telephone committee
• Volunteer work on regular basis at Library
• Newsletter preparation or mailing
• Book Sale
• Annual membership drive
• Provide treats for Library occasions