Memorial and Tribute
Gift
Name as you wish it to be listed in the Annual Report:
_____________________________________________________________
____ I wish to remain anonymous.
Address_______________________________________________________
City_________________________State_______Zip____________________
Phone_________________________________________________________
E-mail_________________________________________________________
| In honor of: | _________________________________________ |
| Occasion: | _________________________________________ |
| In memory of: | _________________________________________ |
| Please notify: | _________________________________________ |
| Address: | _________________________________________ |
| City/State/Zip: | _________________________________________ |
| Category of materials: | _________________________________________ |
$____________________ Gift
amount |
| _____ | Check enclosed made out to Westport Public Library | ||||
| _____ | Charge my gift to | _____ | MasterCard | _____ | Visa |
| Card # | ________ - ________ - ________ - ________ | |||
| Exp. Date | ____ /____ | |||
| Name on Card | ________________________________________ | |||
| Signature | ________________________________________ | |||
___ I am enclosing a matching gift form.
Membership gifts are tax-deductible as provided by law. Westport Library is a registered 501(c) (3) cultural organization.
Mail to:
Westport Public Library
20 Jesup Road
Westport, CT 06880
dcelia@westportlibrary.org