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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Email Address
    For Newsletters and other Friends news/events.
14. Telephone Number
16. Membership Level*
    -- Select One --$15 Member$25 Family$100 Patron$250 Benefactor$500 Advocate$1,000 PhilanthropistOther Donation
18. Amount donated*
    Enter the dollar amount you wish to donate.
19. My gift will be matched by:
    Please send the appropriate form to: Friends of Buckham Memorial Library, 11 Division St. E., Faribault, MN 55021.
21. You may pay for your membership via our secure PayPal server or by check. (Please make your check payable to: Friends of Buckham Memorial Library.)*

    1. I will be paying via PayPal. (After this form is submitted, click on the link provided to be forwarded to our secure PayPal site.)
    2. I will be paying by check. (Please send check to Buckham Memorial Library, Attn: Friends of Buckham Memorial Library, 11 Division St. E., Faribault, MN 55021)
23. Thank you!
    Your support makes it possible to continue valuable programs that touch so many families and individuals, and makes a positive impact in the community. Thank you for being a Friend!
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25. 1. Receive an email copy of this form.
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