In memory/honor of: *

First Name

Last Name

Preferred Audience/Format (optional)

This describes what you would prefer be purchased by the library with the funds from your gift.

Children's Books

Adult Books

Audiobooks

Large Print Books

DVDs

Would you like to have a notification of your gift sent to kin of deceased or to honoree? *

Name and mailing address of notified individual must be provided on this form for a notification to be sent.

Yes

No

Notification Name

First Name

Last Name

Notification Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country