FRIENDS OF THE NJ LIBRARY f/t BLIND MEMBERSHIP FORM

Name:__________________________________________________

Address:________________________________________________

City, State, Zip:___________________________________________

Telephone (with area code):_________________________________

E-mail address:__________________________________________

Preferred Media Format: LP_____, Tape______ or E-mail______

I am eligible for NJLBH Services: Yes ___, No ___

Individual Member $15.00 ___
Family Membership $30.00 ___
Donation $ _________

Donation in Memory of:
Name:_______________________________________________

Send acknowledgment for memorial gift to:

Name:__________________________________________________

Address:________________________________________________

City, State, Zip:____________________________

I have made a bequest in my will ___

Please return this form together with your membership check payable to:
Friends of the NJLBH
PO Box 434 Woodbridge, NJ 07095
Fall 2007

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New Jersey Library For the Blind and Handicapped
November 25, 2007
Comments to: njlbh@njstatelib.org

The New Jersey Library for the Blind and Handicapped, a division of the New Jersey State Library, is supported by funding from the State of New Jersey and the Institute of Museum and Library Services through the Library Services and Technology Act and is a cooperating network library of the National Library Service for the Blind and Physically Handicapped of the Library of Congress. The New Jersey State Library is affiliated with Thomas Edison State College.