Donation Form

Please print and mail this form with your donation to:

Penelope B. Johnson, Head Librarian
Worcester Public Library
3 Salem Square
Worcester, MA 01608

My/Our donation to the Library is $__________________
Please make your check payable to the Worcester Public Library Foundation.

Name: _______________________________________________________

Address: _____________________________________________________

City:______________________ State: ________ Zip Code: _____________

Gifts may be made to the Library in honor or in memory of a person, to celebrate a family event or to mark any special occasion.

This gift is in memory of :__________________________________________

This gift is in honor of:_________________ on the occasion of_____________

Please notify: _____________________________________________ of my gift.

Their address: _________________________________________________

City: __________________________ State: ____ Zip: _________________

Your contribution is tax-deductible to the extent provided by law.

05/10/04