SUBMISSION FORM

Please print.

This information will be used for the Clubs and Organizations section of the Library's homepage on the Internet.

The Library reserves the right to accept or reject information based on its established policies.

Please remember to notify us of any changes that may be required to the listing once the listing is posted to the database.

Club/Organization:

Street Address:

City/State/Zipcode:

Contact:

Contact Phone Number:

Fax:

Email Address:

Internet Address:

Meetings/Days & Hours/Locations:

Meetings Open to Public:

Non-Profit Status:

Description of Organization and Activities:

Fees/Dues:

Eligibility/Membership Information:

Year Established:

I agree to have the information provided on this form posted on the Internet. I understand that the library is not responsible for any changes in the information made by persons who download or transfer the information to their own computer. The library takes no legal responsibility for the accuracy of the information nor for any loss or damage resulting from the use of any such information. An authorized signature is required to post this listing.

AUTHORIZED SIGNATURE:_____________________________DATE:_______

NAME/TITLE/PHONE:______________________________________________

Return completed form to Merry Uk, Fairfield Public Library, 1080 Old Post Road, Fairfield, CT 06824