Adopt A Book form 2003

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Adopt A Book form 2003 Powered By Docstoc
					                                Remembered
                             in Words and Deeds
                 Honor a special friend or loved one with a commemorative bookplate
                         placed inside a book in the Glendale Public Library.

A letter will be sent to the recipient or the recipient’s family indicating that a book has been placed on
the shelves of the Glendale Public Library in their honor or memory.

                      ❑ In honor of                   ❑ In memory of

RECIPIENT’S NAME            ____________________________________________


       NAME / ADDRESS of RECIPIENT OR
                                                                                   TYPE OF BOOK
             RECIPIENT’S FAMILY
                                                              ❑     Children’s ($20 each)
________________________________________
Name
                                                              ❑     Adult Fiction ($25 each)
                                                              ❑     Adult Non-Fiction ($40 each)
________________________________________                      ❑     Please choose an appropriate book for me
Street Address                                                ❑     I would like to help choose the type of
                                                                    book. Please call me.
________________________________________
City/State/Zip




                                    INSCRIPTION (25 words or less)

       ____________________________________________________________________________________

       ____________________________________________________________________________________

       ____________________________________________________________________________________

                                                                      Please enclose a check for the total
                                                                      amount made out to:
YOUR NAME / ADDRESS / DAYTIME PHONE                                   GLENDALE PUBLIC LIBRARY

_____________________________________________                         Send this form and your check to
Name                                                                  Chuck Wike
                                                                      Glendale Public Library
_____________________________________________                         222 East Harvard Street
Street Address
                                                                      Glendale, CA 91205
_____________________________________________
City/State/Zip                               DAYTIME PHONE            Please us one form per book.
                                                                      Call Chuck Wike, (818) 548-2042, for
                                                                      more information.
                               Your donation is tax exempt to the extent allowed by law.