Make a Lasting Gift


Please Print

Name ____________________________________Phone______________
Street _______________________________________________________
City________________________________ State _____ Zip  ___________
I will contribute: ____$15 ____$25  ____$50  ____ $75  ____$ 100  ____other

Medium: ____ book  ____ magazine subscription  ____ compact disc
 ____book-on-cassette ____videocassette ____ unspecified   ____ other

Preferred title or subject(s):  ______________________________________
____adult dept. ____ children's dept. ____ either

Circle one and fill in the blank:
a.  In Honor Of:  _________________________________________________
b. To Commemorate:  _____________________________________________
c. In Memory Of:  ________________________________________________
d. In Appreciation Of:  _____________________________________________

Individual to be notified about your donation:
Name  _________________________________________________________
Street  _________________________________________________________
City  ____________________________________ State  ____ Zip __________

Please enclose your check made payable to:  Avon Free Public Library.
Cut out form and return with check to: Director, Avon Free Public Library,
281 Country Club Road, Avon, CT 06001

Thank you for your tax-deductible donation.

Back