Friends of the New Jersey Library for the Blind and Handicapped - Membership Form

THE FRIENDS OF THE NJ LIBRARY for the BLIND MEMBERSHIP FORM

Name: _______________________________________________

Address: ______________________________________________

City, State, Zip: ________________________________________

Telephone (with area code):_______________________________

E-mail address: ________________________________________

Preferred Media Format:

LP____ E-mail_____ or None I will read online_____

I am eligible for TBBC Services: Yes ___ No ___

Individual Member $10.00 ___ Family Membership $25.00 ___

Donation $ _________

Donation in Memory or Honor of:

Name: _______________________________________________

Send acknowledgment for memorial gift to:

Name: _______________________________________________

Address: ______________________________________________

City, State, Zip: ________________________________________

I have made a bequest in my will _____

Please return this form together with your check payable to:
The Friends of the NJLBH
PO Box 434, Woodbridge, NJ 07095