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A Library Community
of Color
Please Print ______New Membership ______Renewal
__ Mr. __ Mrs. __ Ms.__ Dr.
Last
Name _______ First Name MI
Home
Address
City_______________________ State___________ Zip
Code_________
Telephone
Number ______ __ Email Address:
Business
Name & Address
City______________________ State_____________
Zip Code________
Telephone
Number ______
Email Address
Preferred
Contact: __
Home __
Business
May we share your preferred contact
information with other Cornucopia members?
_____Yes ______No
Type of
Library/Institution: _ Academic __ Public __ School ___ Special
_ Board/Trustee _ Library Student __ Name of School ______________
_ Retired _ Government _ Other ___________
Interests: __ Membership __ Hospitality __ Programming __ Website
__ Public Relations & Outreach __ Other
_______
2018 MEMBERSHIP
DUES $ 20.00
2018
Student Membership Dues $ 5.00
Additional
Donation (optional) $
TOTAL Submitted $
Please make money order or checks
payable to Cornucopia of Rhode Island
Please mail application and payment to:
Ida
D. McGhee, Treasurer P. O. Box 491, West
Kingston, RI 02892
Office Use Only
Date Received _____________ Payment
Type________________ Date of Deposit__________
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