Name:_________________________________________________________________

Address _______________________________________________________________

City: ______________________State:_________________ Zip Code: _____________

Phone: home _________________ work ________________

Email: ______________________________________

Please check one:

New _____  Renewal _____  Gift membership _____  From:  ________________________

Please check one:
Individual:  One year $7.00 _____ Three years $14.00 _____
Family:       One year $10.00 _____ Three years $22.00 _____
Junior (Grades K-12):  One year $1.00 _____
Life Member:  $100.00 _____
Additional Donation (Tax deductible):  $ _____
Please make check payable to the Friends of the Mishawaka-Penn-Harris Public Library.

Please check one:
I would like to receive the newsletter only. _____
I would like to volunteer at the library on a regular basis. _____
I would like to help with special projects: book sales _____
      children’s activities _____
      staff luncheon _____
      other _____________________________
 

Date ____________ Signed _____________________________________________
 

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