Edgecombe County Memorial Library

Memorial Gift Form

PLEASE PRINT ALL INFORMATION

Return form to Edgecombe County Memorial Library Circulation Desk or mail to:  Edgecombe County Memorial Library, Memorial Gifts, 909 Main Street, Tarboro, North Carolina 27886.  Please make checks payable to:  Edgecombe County Memorial Library.

DONOR INFORMATION

1.       Name: _________________________________________________________________________

2.       (Organization):  _________________________________________________________________

3.       Address:  _______________________________________________________________________

      City: _______________________________   State:  ______________  Zip:  ________________

4.   Phone:  (       ) ___________________________________________________________________

5.   Name of other donors:  ___________________________________________________________

DEDICATION INFORMATION

Dedicated in memory of

Name:  ___________________________________________________________________________

Dedicated by:  ______________________________________________________________________

__________________________________________________________________________________

(If more than three names, use group name.)

GIFT ANNOUNCEMENT RECIPIENT(S) INFORMATION

1.       Name:  _________________________________________________________________________

2.       Address:  _______________________________________________________________________

      City:  _______________________________   State:  ________________  Zip:  _______________

MATERIAL TO BE DEDICATED

1.       Type of material:  _________________________________________________________________

(Specify general guidelines such as large print books, children’s books, etc.)

 

2.       Subjects of interest:  ______________________________________________________________

__________________________________________________________________________________

(Subjects from which you would like the material selected such as Biographies, Travel, Flowers, Sports, Cooking, History, Mysteries, Westerns, etc.)