HeySurvey survey

Please complete this form for all Memorial and Honorarium gifts.

Donor's name:*

Who is making the donation?

Donor's address:*

Donor's email:*

Person honored with donation:*

Donation to be made*

In Memory of
In Honor of
In Celebration of
In Appreciation of

Would you like us to inform the family about your generous donation?*

Yes
No

If yes, please provide their name and full address below:

What type of book would you like the donation to be used for?*

Adult Fiction book
Adult Non-Fiction book
Children's Fiction book
Children's Non-Fiction book
No preference
Other

Please indicate the title if you'd like a specific book:

Date of donation:*

Amount gifted:*

Thank you for taking the survey!

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