Friends of RML Corporate Membership Form

Please complete the following information.

Name: x

Address:

Phone: x

Email:

Please choose a level of membership.

check one	x	x
x	$30.00	Supporting
x	$50.00	Patron
x	$100.00	Century Club
x	$125.00	Gold Club
x	______ (fill in amount over $125.)	Platinum Club

Your check should be made payable to:
"Friends of Richards Memorial Library"

Membership applications may be dropped off at the library or mailed to:
Richards Memorial Library
44 Richards Ave.
Paxton, MA 01612

Thank you for your support.