Wufoo

Applicant Information

Please supply us with the following required information.
Primary Applicant's Name: * First Last
Even if you are submitting a Non-Profit or Corporate membership applications we ask that someone's name is listed as the primary applicant.
Organization Name:

Please include this information if you are submitting this application for a Non-Profit or Corporate membership.
Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Please provide us with your mailing address.
Phone Number: * ### - ### - ####
Please include your primary phone number.
Email: *

Our primary method of communication is via email. Please provide the primary applicant's email address.
Membership Level

Please select one of the following membership levels.
Select One: *
Junior Membership, $5 Individual Membership, $20 Family Membership, $35 Patron Membership, $75 Sustaining Membership, $200 Non-Profit Membership, $25 Corporate Membership, $75

Junior membership is reserved for individuals under the age of 18. Individual membership is for all individuals over the age of 18. Family membership can include a total of 4 individuals. Sustaining membership is a 5-year individual membership. Non-profit membership is required to include the organization's tax identification number. Corporate membership is for all other businesses and/or organizations.
Tax Identification Number:

For Non-Profit applicants please provide your tax identification number without the dash.
Family Members:

For those applying for Family membership please include the names (first and last), relationship to applicant (ex. husband, daughter, etc.), and their email address if available. For example: John Doe, Husband, johndoe@mail.com.
I would be interested in the following:

Select any of the items that you would be interested in assisting with.
Select Choice(s):
Library Fair Membership Drive Newsletter/Publicity Book Sales I would like to be a Friends Officer

Let us know how you'd like to be involved!
Member Benefits

As a member of the Friends you will receive a membership card and other benefits/rewards. Please select one of the following books.
Select One: *
'History Stories of Milledgeville and Baldwin County' by Leola Beeson 'History of Baldwin County Georgia' by Anna Maria Green Cook 'Remembering Milledgeville: Historic Tales From Georgia's Antebellum Capital' by Hugh T. Harrington No preference

Let us know which book you'd like us to send you as a new member of the Friends.
Signature

As the Primary Applicant of this membership, I attest that the information that I have provided is true. I also acknowledge that I will receive my membership card(s) and additional information if any within two weeks from today's date. I also understand that my membership, unless it is at the 5-year sustaining level, is valid for one year from the date I submit this application.
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Wufoo

Applicant Information

Membership Level

I would be interested in the following:

Member Benefits

Signature