Membership Form for Friends of Kountze Public Library Please print this form and mail or bring it to the library. Friends of Kountze Public Library 800 South Redwood Street Kountze, Texas 77625 Name:  _____________________________________________________ Address:  ___________________________________________________ City, State & Zip Code:  ________________________________________ Enclosed is my check for: Junior/Student $ 1 Individual Active $ 20 Individual Supporting $ 30 Family $ 25 Corporate $ 100-1000 Life $ 250 Other ways to assist the Friends:  I can't join, but I want to help.  I am interested but need to know more.  I can't attend the meetings but I want to help the library.  You can count on me for:  __________________________________________________________  __________________________________________________________  __________________________________________________________  Please phone me at: _______________________________________ The Friends of the Kountze Pubic Library is a 501(c)3 non-profit, and donations are tax deductible.

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