FRIENDS OF LIBRARY ACCESS, INC
Application and Renewal Form
Please complete this form and return it along with your check(s) to: 
Friends of Library Access, Inc.
P.O. Box 10716
Daytona Beach, FL, 32120-0716
Today's Date: _________________________
NAME: Last ______________________ First ___________________________
Street _____________________ Apt. _____
City _______________________ State _____  Zip _______
Telephone: (home) (_____)_____-_____
                (work) (_____) __________
   PLEASE CHECK ALL THAT APPLY
Are you a customer of the Braille and Talking Books Library? ___yes ___no  
Do you have a disability?  ___yes   ___no  
If yes, what is your disability? ________________                           
        Reader Number ________________                           
1.  FLA Membership Selection  
__ Annual renewal ($10.00 per year)
__ Contributing Member ($50.00 or more per year)
__ Life Member  ($200.00)
__ Supporting Membership ($250.00 per year group sponsorship) 
 I am interested in helping with:
__ F.L.A. Board of Trustees
__ Fund Raising
__ Public Relations/Education