You may print out this form and mail the completed form with your check to:

Des Plaines Public Library
Attn: Administration
1501 Ellinwood Street
Des Plaines, IL 60016

Name _____________________________________________________________

Address ___________________________________________________________

City ______________________________________________________________

State _______________________   Zip _________________________________

Phone ____________________________________________________________

To honor or remember a loved one or to celebrate a special event, please specify in the space below:

Make check payable to: ILSDO Fund
Enter Des Plaines Public Library on the memo line on your check.

Your contribution is tax deductible to the extent allowed by law.