Friends of the Valle Vista Library

MEMBERSHIP APPLICATION


Name: __________________________________ Date: ___________
Mailing Address:  ___________________________________________
  ___________________________________________
Telephone: ___________________________________________
Type of Membership: ____ Individual/Family ($5)
  ____ Patron ($25)
  ____ Sponsor ($50)
  ____ Benefactor ($100)
  ____ Life ($250)
  ____ Check here if this is a renewal.
Dues and contributions are tax-deductible to the extent allowed by law.
Shall we call to notify you of Friends meetings? ____Yes ____No

Please check the areas in which you are most interested in participating:

____ Programs
____ Public Relations
____ Building membership
____ Money-raising projects
____ Summer Reading Program for Children
____ Volunteer services at library
____ Attend meetings of the Mohave County Library District Citizen's Advisory Committee
____ Speaking to local groups about library services and needs

Please print and complete this application.  After completing the application, just mail the form with your membership contribution to:

Friends of the Valle Vista Public Library
c/o Valle Vista Library
7193 Concho Drive
Kingman, AZ  86401