www.milibrary.org

Membership Form

Submitted by Anonymous on Wed, 06/01/2011 - 10:40am

Title: *

Mr.

Mrs.

Ms.

Name: *

Address: *

City: *

State: *

Zip: *

Phone: *

Phone (alt):

Email: *

Date of Birth: *

Emergency Contact: *

Phone: *

Have you previously been a member?: *

No

Yes

How did you learn about MI?

Membership Category: *

$35 - Student - Must show class schedule

$95 - Individual

$150 - Family/Household - 2 adults and children under 22 years

$250 - Associate

$500 - Patron

$1000 - Benefactor