*** Please print this page, fill it out and place it in the envelope with your membership check ***

FRIENDS OF THE WEST ISLIP LIBRARY

Membership Application

Name:   ________________________________ Date:   ________________________________
Address:   ________________________________ Telephone:   ________________________________
 

 

  ________________________________

 

Email:

 

  ________________________________

 

Membership Year: January to December

 

Patron: $50 ______ Contributor: $10 ______ Renewal: ______
Sponsor: $25 ______ Supporter: $5 ______ New: ______