Memorials/Honorarium

Donor's Name

Donor's Company

Donor's Email

Donor's Phone

Donor's Address

Address 2

Donor's City/Town

Donor's State/Province

Donor's ZIP/Postal Code

Title

Memory/Honor of First Name

Memory/Honor of Middle Name

Memory/Honor of Last Name

Suffix

Item(s) to be purchased or supplied by donor (Fiction/Non-Fiction, Romance, Fantasy, Science Fiction etc., or History, Gardening, or Cooking etc.):

Notification sent to Name

Notification sent to Address

Address 2

Notification sent to City/Town

Notification sent to State/Province

Notification sent to ZIP/Postal Code

Submission Instructions

If mailing a check, please mail the completed form and payment to: Austin Memorial Library 220 S. Bonham Ave. Cleveland, TX 77327 If submitting the form online and paying by credit card, please call the library at 281-592-3920 to arrange payment. If donating an item, please print the completed form and bring it, along with the donated item, to the library.