Back to Membership Information:

To Become a Member

Please send this form filled out and with membership dues to the following address, or fax to:
Friends of the Thomas Balch Library, Inc.
P.O. Box 2184
Leesburg, VA 20177
Telephone: 703-737-2166
Fax: 703-737-7150
www.balchfriends.org

Membership Dues

Benefactor	...............$250 and above
Sustaining	...............$100
Patron	...............$50
Business/Professional	...............$35
Family	...............$25
Individual	...............$20
Student or Senior	...............$15
No, I would not like to join, but would like to make a tax deductible contribution	...............$__________ The Friends of Thomas Balch Library, Inc. is a 501(c)3 corporation.

Contact Information:

Date: ________________

Name: _______________________________________________

Mailing Address: _______________________________________

City_____________________State_________Zip_____________

Email________________________________________________

Telephone: _________________________________

Billing:

Please make checks payable to: Friends of the Thomas Balch Library, Inc.

Please bill to my credit card: VISA Mastercard: (circle one)

#________________________ Expires _______ Signature:_______________________________

Thank You from the Friends of Thomas Balch Library!