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

Friends of the West Islip Public Library

Membership Application

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

 

   ________________________________

 

 Email:

 

   ________________________________

 

Membership Year: April to March

 
Patron: $25 ______ Contributor: $10 ______ Renewal: ______
Sponsor: $15 ______ Supporter: $5 ______ New: ______

 

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