Donation Form
Commemorative Book Donation Form
Please print and mail this form with your donation to: Wei Jeng-Chu, Head Librarian, Worcester Public Library, 3 Salem Square Worcester, MA 01608
My/Our donation to the Library is $__________________(average
book price: $30)
Please make your check payable to the Worcester
Public Library.
Name: _____________________________________________________
Address: _____________________________________________________
City:_______________State: ________ Zip Code: ___________
I/We would like this gift to be used for
the purchase of books in the following subject
area(s): ______________________________________________________
Gifts may be made to the Library in honor or in memory of a person, to celebrate a family event or to mark any special occasion.
This gift is in memory of :___________________________________
This gift is in honor of:__________________________________
on the occasion of_________________________________________
Please notify: __________________________________ of my gift.
Their address: _________________________________________________
City: ___________________State: ____ Zip: ___________
Your contribution is tax-deductible to the extent provided by law
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