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Print off this form and mail to the address at the bottom of the application or bring into the library. Forms are also available in the library.
Membership/Annual Support
Payment enclosed for the year of _______. (Please enter year.)
Membership begins January 1st and ends December 31st.
Name: _________________________________
Address: _______________________________
City: _____________ State: ____ Zip: _______
Please select the appropriate membership or contribution:
___ Student $5
___ Individual $10
___ Family $25
___ Organization $75
___ Business $100
___ Corporation $250
___ Sustaining Member $500
___ Contribution $________
Make checks payable to “The Friends of the Library.”
Send your check with this form to:
Friends of the Library
Centralia Regional Library District
515 East Broadway
Centralia, IL 62801
Address questions to:
Joyce Jackson, Library Director
618-532-5222 extension 201
jjackson@shawls.lib.il.us
