Friends Membership Application

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

Friends of the West Islip Public Library

Friends of the West Islip Public Library

Membership Application

Name:

________________________________

Date:

________________________________

Address:

________________________________

Telephone:

________________________________

________________________________

Email:

________________________________

Membership Year: January to December

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