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Membership Join or Renewal Form


* Membership Type:
Please select the appropriate type for your membership.
* Prefix:
* First Name:
 * Last Name:
* Address:
 Address 2:
* City:
 * State/Province:
* Zip/Postal:
 * Country:
* Home Phone:
 * Work Phone:
*Date of Birth:

Month
Day
Year
* Email:
* How do you wish your name(s) to appear in print?
For Family, Grandparent, or Donor Circle memberships, please name one additional adult and their date of birth.
Name:


Date of Birth:

Month
Day
Year
Joining is easy
* Please choose your preferred membership type below.
Member's Circle





 Donor's Circle




  
Hamilton Circle Membership ($100+)
 Joyce Leckrone Friends of the Library ($25+)
 Additional Gift
$

$

$

* Senior memberships available for age 65+
* Signature:
Please type your initials to sign your application.
* Credit Card Number:


* CC Expire Date:


* CVV2:


 Total:
$0.00
By submitting this form, you are giving the FWMoA permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.
* Required Fields

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311 E Main Street
Fort Wayne, IN 46802
Gallery Hours Tuesday - Saturday: 10am-6pm
Thursday: 10am-8pm
Sunday: 12-5pm
Administrative Office Hours Monday - Friday: 8:30am-5pm
P: (260) 422-6467
F: (260) 422-1374