Name ___________________________________________________________

Phone ______________________________________________________

Address ________________________________________________________________________

email address (optional) ________________________________________________

Date ______________________

With the exception of "Individual Life" and "Corporate Life" memberships, all membership terms are for one year. Circle the level of membership for which you are applying:

Senior Citizen or Student . . . . . . . . . $5.00
Individual . . . . . . . . . . . . . . . . . . $10.00
Family . . . . . . . . . . . . . . . . . . . . $15.00
Patron . . . . . . . . . . . . . . . . . . . . $25.00
Sustaining . . . . . . . . . . . . . . . . . . $50.00
Business or Civic . . . . . . . . . . . . . . . $150.00
Individual Life . . . . . . . . . . . . . . . . $250.00
Corporate Life . . . . . . . . . . . . . . . . . $1,000.00

Please make checks out to "Friends of Massillon Public Library."

Helping Hands
Please check below if you would be willing to assist the Friends with any of these projects:

BOOK SALE
Set Up / Take Down ____________
Cashier _______________________

FUNDRAISING
Membership Drive __________________
Community Events __________________

PROGRAMMING
Planning Events ___________________
Promotion _________________________
Poster Distribution __________________ 		COMMITTEE MEMBERSHIP
Bus Trips ___________________
Genealogy ___________________
Hospitality _________________
Membership __________________
Publicity ___________________

TELEPHONING _______________

__________ I wish to be a "quiet" Friend and do not want to be actively involved in Friends projects.

Thank You for Your Support!