MEMBERSHIP APPLICATION

Friends of the Columbia County Public Library

                                                                 _____ New Membership

                                                                 _____ Membership Renewal

Join or renew now - Membership goes to February 2012

                                                                 _____ Individual ($5)

                                                                 _____Family ($10)

                                                                 _____ Organization ($25)

                                                                 _____ Sustaining Donor ($50)

                                                                 _____ Sponsor ($100)

                                                                 _____ Contributing ($________ )

Name_________________________________________________________________________________________________

Address_______________________________________________________________________________________________

City____________________________________________________ State____________ Zip Code___________________

Telephone Number______________________________________________________________________________________

E-mail Address_________________________________________________________________________________________

A copy of the official registration (#SC-05830) and financial information may be obtained from the Division of Consumer Services by calling toll-free 1-800-435-7352 within the state.  Registration does not imply endorsement, approval, or recommendation by the state.  This organization retains 100% of all contributions received.

Please make checks payable to:

Friends of the Columbia County Public Library

308 NW Columbia Avenue

Lake City, Florida 32055

(386) 758-1018

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