MEMORIAL BOOK DONATION FORM

DATE:________________________

DONATION FOR THE PURCHASE OF A BOOK IN MEMORY or HONOR OF:

________________________________________________________________________________________________________

IF BOOK DONATION IS IN HONOR OF A SPECIAL OCCASION, PLEASE LIST THE OCCASION AND ACKNOWLEDGEMENT WILL GO TO THE NAME ABOVE:

________________________________________________________________________________________________________

________________________________________________________________________________________________________

ACKNOWLEDGEMENT TO FAMILY SHOULD BE SENT TO:

NAME:_________________________________________________________________________________________________

ADDRESS:_____________________________________________________________________________________________

________________________________________________________________________________________________________

DONOR INFORMATION:

NAME:_________________________________________________________________________________________________

ADDRESS:_____________________________________________________________________________________________

________________________________________________________________________________________________________

PHONE NUMBER:______________________________________________________________________________________

*PLEASE NOTE: MINIMUM BOOK MEMORIAL IS $20.00*
(Make checks payable to Vineland Public Library)

AMOUNT DONATED____________ CHECK____ CASH____

SUGGESTIONS (HOBBIES OR SUBJECTS OF SPECIAL INTEREST):

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

FOR LIBRARY USE ONLY: LETTERS SENT:
RECEIVED BY (STAFF INITIALS) ____________ 1ST ____________
Rev. 11/05 2nd ____________