Friends of the Derby Public Library

Derby Public Library

313 Elizabeth Street   

Derby, CT 06418

Phone: 203-736-1482

Fax to: 203-736-1419

Name: ______________________________________

Address:  ___________________________________

                ___________________________________

                ___________________________________

Home Phone: _________________________________

Hours of Availability: ________________________________________________

Occupation: _______________________________________________________

Business:  _________________________________________________________

Work Phone: ______________________________________________________

E-mail address _____________________________________________________

I would like to be a:

     Student Friend - $2.50 annual fee

     Active Friend - $5.00 annual fee

     Supporting Friend - $7.00 annual fee

     Benefactor - annual fee of $25.00 or more

     Corporation/Business Sponsor annual fee of $50.00 or more

     No, I would not like to be a Friend of the Library, but would like to make a donation of $