DONATION FORM

Name: _______________________________

Address: _________________________________

City: ___________________ State: _______ Zip Code: _____________

Enclosed is a check payable to the Friends of the Ashland Public Library in the amount of $_____________.

This contribution is ____ not dedicated ____ dedicated

Please check the appropriate dedicated category:

____ Children's Programs ____ Books ____ Art

____ Software ____ Equipment _____ Other : ____________________________________________

All contributions are tax deductible (Federal ID #31-1576133, Oregon registration #15327.) Please make your check payable to: Friends of the Ashland Public Library.

Please print this form and mail it and your donation to:

PO Box 91, Ashland, OR 97520

or put it in the box across from the circulation counter in the library.

THANK YOU!