Tuesday, February 21, 2012

you will receive an email confirmation for your request.

full name:

email address:

phone number:

myself and 0 1 2 3 guests will be attending

full name:

full name:

full name:

parent or guardian:

relationship to child:

I give the library permission to use my name and photograph or my child’s (children’s) name and photograph in all form and media for publicity purposes.

yes no

Where did you hear about this program?

Library Website Newspaper At library At school Radio TV Other

Please email me information about new events.

yes no

Do you require special accommodations?

yes no

please describe:

additional comments: