Please provide the following information:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
FAX
E-mail
Otterbein Class Year

Please indicate which of the following apply:

Renewal

New Membership

Choose one of the following options:

Imaginative Friend (Generous donation of your choice).  Please describe this donation.
Philanthropist ($500 +)
Benefactor ($100 - 499)
Contributor ($50 - $99)
Family: Two or more people in the same household ($35)
Individual Friend ($20)
Otterbein Student ($5)

NOTE:  To qualify as an Imaginative Friend, you must discuss your donation with Lois Szudy, Library Director to be sure your donation places you in this category.

One benefit to being a Friend is borrowing privileges at the library.
Are you interested in receiving borrowing privileges?

Yes. 

No

The library reserves the right to deny borrowing privileges under certain circumstances.

Total Amount Remitted:

Today's Date: 

Method of Payment:

Cash

Check

To insure proper gift credit, please make checks payable to Otterbein College.  
Contributions are tax deductible in accordance with Internal Revenue Service rules.

Please print and mail form to:

Lois F. Szudy
Courtright Memorial Library
1 Otterbein College
Otterbein College
Westerville, OH 43081