FRIENDS OF THE LOCKPORT PUBLIC LIBRARY, INC.

MEMBERSHIP FORM


Name: ____________________________________

Address: _________________________________

__________________________________________

__________________________________________

Phone: ___________________________________

E-mail: __________________________________

Type of Membership: ______________________

Amount Remitted: _________________________

Please drop form and payment off at the
Floor 2 Circulation Desk.



For Office Use Only Date Received:

_____________________

_____________________




04/2006