PLEASE COMPLETE
THIS SIDE
THIS SIDE FOR
OFFICE USE ONLY

Date: ________
Amount Donated:
$___________
Method of Payment:
Cash
Check
Credit Card

Card #:
___________________
VISA
MasterCard
Discover

Exp. Date ___________

Cardinal Card #: __________
Barcode #: 7777_______8888

Added to Millennium:
Yes
No


Date Added: _______

Staff Initials: _____

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

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

If you marked Yes above, please provide your Drivers License Number (required)

 

 

Member signature: _________________________

By signing (below) I agree that I will abide by the loan policies of the Courtright Memorial Library. I will be responsible for all items I check out and their replacement costs should they become lost, stolen, or damaged. I understand that the Courtright Memorial Library reserves the right to take collection actions if my account is over 60 days past-due.

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

Please print and mail form to:

Lois F. Szudy
Courtright Memorial Library

Otterbein University

1 S. Grove St.

Westerville, OH 43081

Return to Membership


Last revised: March 29, 2007