Join Today: Friends Group Associate Membership Form </head> <body id="Membership"> <div id="outer"> <div id="container">  <div id="utilBox"> <div id="utilNav"> <span id="utilHome"><a href="/index.php">Home</a></span> <span class="post">|</span> <span id="utilLogin"><a href="/member-login.php">Member Login</a></span> <span class="post">|</span> <span id="utilJoin"><a href="/membership/index.php">Join Now</a></span> <span class="post">|</span> <span id="utilSitemap"><a href="/sitemap.php">Sitemap</a></span>  <form method="get" action="http://search.atomz.com/search/"> <input type="hidden" name="sp_a" value="sp10026408"> Search: <input size="15" name="sp_q"> <input type="submit" value="Go"> <input type="hidden" name="sp_p" value="any"> <input type="hidden" name="sp_f" value="ISO-8859-1"> </form> </div> </div> <a href="/index.php"><img src="/images/img_logo.gif" alt="" class="banner" /></a> <img src="/images/img_banner_1.gif" alt="" class="banner" /> <img src="/images/img_banner_back.gif" alt="" class="bannerCap" /> <ul id="nav"> <li class="cap"><img src="/images/nav_left_corner.gif" alt="" /></li> <li id="globalAbout"> <a href="/about/index.php">About FOLUSA</a> <ul> <li><a href="/about/who-we-are.php">Who We Are</a></li> <li><a href="/about/board-members.php">Board Members</a></li> <li><a href="/about/executive-director.php">Executive Director</a></li> <li><a href="/about/sponsors.php">Sponsors</a></li> <li><a href="/about/partners.php">Partners</a></li> <li><a href="/about/membership.php">Membership</a></li> <li><a href="/about/donate-books.php">Donate Books</a></li> </ul> </li> <li class="post"></li> <li id="globalMembership"> <a href="/membership/index.php">Membership</a> <ul> <li><a href="/membership/renewals.php">Renewals</a></li> <li><a href="/membership/all-in-one.php">All-In-One</a></li> <li><a href="/membership/friends-groups.php">Friends Groups</a></li> <li><a href="/membership/libraries.php">Libraries</a></li> <li><a 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Online Order Form</h1> <p> <p><table> <tr><td colspan=2 valign=top><font face="Arial, helvetica,Geneva"> <font size=-1> <p>To pay by check, complete the form, print, and mail with your check or money order, payable to FOLUSA. Send to:<BLOCKQUOTE>Friends of Libraries U.S.A.<BR> 109 S. 13th Street, Suite 3-N<BR> Philadelphia, PA 19107<BR></BLOCKQUOTE> </td> <td colspan=2 valign=top><font size=-1><font face="Arial, helvetica,Geneva"> To pay by Visa, Mastercard, Discover Card, or American Express, complete the form and click the "Submit" button to send the information and pay via a secure server. </td> <td valign=top><font face="Arial, helvetica,Geneva"> <b>Outside the USA?</b> <p><font size=-1> Use our <a href="/membership/online-forms/international.php">International Membership Form</a> </td></tr> </table> <p> <table> <FORM METHOD=POST ACTION="https://secure.authorize.net/gateway/transact.dll"> <INPUT TYPE=HIDDEN NAME="x_Header_HTML_Payment_Form" VALUE="Welcome to the secure server payment page. The information you provided on the membership form will be sent to FOLUSA. <b>The only additional information you need to provide is a valid Mastercard or Visa number and expiration date.</b> A receipt form will show your transaction, and a receipt will be e-mailed to the e-mail address you specified on the membership form."> <INPUT TYPE=HIDDEN NAME="x_Version" VALUE="3.0"> <INPUT TYPE=HIDDEN NAME="x_Login" VALUE="folusa307"> <INPUT TYPE=HIDDEN NAME="x_Description" VALUE="Group membership"> <tr><td align=left><font size=-1><font face="Arial, helvetica,Geneva"> <INPUT TYPE=radio NAME=New/Renew VALUE="New member">New Member </td><td colspan=2 align=left><font size=-1><font face="Arial,Helvetica,Geneva"> <INPUT TYPE=radio NAME=New/Renew VALUE="Renewal">Renewing Member </td> <td colspan=3 align="left"><font size=-1><font face="Arial,Helvetica,Geneva"> Membership Number (from your newsletter label) <INPUT TYPE=text NAME="membership number" SIZE=10></TD></TR> </table> <p><center> <table> <tr><td><center><table> <tr><td align=right><font face="Arial,Helvetica,Geneva"><font size=-1> Name of Friends Group:<td> <td align=left> <input type=text NAME="x_company" size=40> </td></tr> <tr><td align=right><font face="Arial,Helvetica,Geneva"><font size=-1> Contact Person:<td> <td align=left> <input type=text NAME="x_ship_to_first_name" size=40> </td></tr> <tr><td align=right><font face="Arial,Helvetica,Geneva"><font size=-1> Mailing Address:<td> <td align=left> <input type=text NAME="x_ship_to_address" size=40> </td></tr> <tr><td align=right><font face="Arial,Helvetica,Geneva"><font size=-1> City: <td> <td align=left> <input type=text NAME="x_ship_to_city" size=40> </td></tr> <tr><td align=right><font face="Arial,Helvetica,Geneva"><font size=-1> State: <td> <td align=left> <input type=text NAME="x_ship_to_state" size=40> </td></tr> <tr><td align=right><font face="Arial,Helvetica,Geneva"><font size=-1> Zip code: <td> <td align=left> <input type=text NAME="x_ship_to_zip" size=40> </td></tr> <tr><td align=right><font face="Arial,Helvetica,Geneva"><font size=-1> Telephone: <td> <td align=left> <input type=text NAME="x_phone" size=40> </td></tr> <tr><td align=right><font face="Arial,Helvetica,Geneva"><font size=-1> FAX: <td> <td align=left> <input type=text NAME="x_Fax" size=40> </td></tr> <tr><td align=right><font face="Arial,Helvetica,Geneva"><font size=-1> Email: <td> <td align=left> <input type=text NAME="x_EMAIL" size=40> </td></tr> </td></tr> </table></center> </table> <p><font face="Arial,Helvetica,Geneva"><font size=-1> This group is a: <INPUT TYPE=radio NAME=group VALUE="Public Library">Public Library Friends <INPUT TYPE=radio NAME=group VALUE="Academic">Academic Library Friends<br> <INPUT TYPE=radio NAME=group VALUE="School">Friends of a School Library <INPUT TYPE=radio NAME=group VALUE="State Friends">State Friends Group<br> <INPUT TYPE=radio NAME=group VALUE="Other"> Other (Please describe): <INPUT Type=text Name=group Size=30> </center> <p> <FONT COLOR="#00008D"><b>To join your branch libraries as Associate Members you must have a Large Friends Group membership at $100 per year.</b></FONT><p> <TABLE> <TR> <TD><font face="Arial,Helvetica,Geneva"><font size=-1> <P><INPUT TYPE=radio NAME=Dues VALUE="100">500 members or more</P> </TD> <TD><font face="Arial,Helvetica,Geneva"><font size=-1> <P>$100</P> </TD> </TR> </TABLE> <p> <table> <tr><td><font face="Arial,Helvetica,Geneva"><font size=-1> <p>Your branch libraries are eligible to join as Associate Membership under your membership at the rate of $30 per branch. Associate Members receive full membership benefits. This opportunity is not available to state library associations, state libraries, or regional consortiums. Payment for the system membership and all associate members must be in the form of a single check or credit card charge sent by the library system. <P>Number of Associate Members ($30 per library): <INPUT TYPE=text NAME=Associate-Libraries VALUE="" SIZE=3> </td></tr> <tr><td><font face="Arial,Helvetica,Geneva"><font size=-1> <br>Send Associate Memberships to: <br /><br /> <center><table> <tr><td><font face="Arial,Helvetica,Geneva"><font size=-1> <INPUT TYPE=radio NAME=Subscription to VALUE="address above">Address above </td></tr> <tr><td><font face="Arial,Helvetica,Geneva"><font size=-1> <INPUT TYPE=radio NAME=Subscription to VALUE="address list">Names and addresses on attached list. </td></tr> </td></tr> <tr><td><font face="Arial,Helvetica,Geneva"><font size=-1> <INPUT TYPE=radio NAME=Subscription to VALUE="address list">List names and addresses for Associate Memberships here: <TEXTAREA NAME="associate-memberships" ROWS=12 COLS=60></TEXTAREA> </td></tr> </table> <P><center><b>Payment Options</b><p> <INPUT TYPE=radio NAME=check> I enclose my check in the amount of $ <INPUT TYPE=text SIZE=4><br> <INPUT TYPE=radio NAME=check> I will pay $ <INPUT TYPE=text NAME="x_Amount" SIZE=4> by credit card.<P><BR> <INPUT TYPE="Reset" VALUE="Clear Form"> <INPUT TYPE=HIDDEN NAME="x_Show_Form" VALUE="PAYMENT_FORM"> <INPUT TYPE=SUBMIT VALUE="Click here for secure credit card payment form"> </FORM> </table> </p> </div> </div> <div id="rightCol"> <div id="rightColContent">  </div> </div> </div>  <div id="footer"> <div class="block">Friends of Libraries USA<br />(FOLUSA)</div> <div class="block">109 S. 13th Street, Suite 3N<br /> Philadelphia, PA. 19107</div> <div class="block">215-790-1674<br /> or 1-800-9FOLUSA or 1-800-936-5872</div> <div class="blockLast"><a href="mailto:friends@folusa.org">friends@folusa.org</a></div> <br><br> </div> <script src="http://www.google-analytics.com/urchin.js" type="text/javascript"> </script> <script type="text/javascript"> _uacct = "UA-279912-3"; urchinTracker(); </script> </div> </div> </body> </html>