Friends of Literacy Membership Form
First Name
Last Name
Email
Phone
(input 1, area code and number, no spaces or dashes)
Street Address:
City
State
Zip
Type of Membership
$10 - 49 Individual Friend
$50 - 99 Family Friend
$100 - 499 Supporting Friend
$500 - 999 Sustaining Friend
$1,000 - Plus Chairman's Circle
Contribute Monthly
Contribute Monthly
Amount of Contribution:
$
Will you add 3% to this purchase to help cover our online expenses and processing?
Yes
Total Due:
Pay in Person
Pay at Literacy Connections Office with Cash or Check
Click
Submit
to Pay with PayPal, then click the Yellow PayPal button on the next screen.
If you are paying by check or cash, please check the
Pay at Literacy Connections Office
with Cash or Check
checkbox, then click
Submit
.
Paypal_Hidden_Fields
Account ID
Contact ID