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:
Organization Type: (Please circle up to 3)
| Advocacy | Cultural | Information | Service |
| Animals | Disabled | Men | Singles |
| Arts | Education | Military | Speaker/Speakers |
| Automobiles | Environment | Music | Sports |
| Business | Ethnic | Newcomers | Support Groups |
| Children | Finance | Professional | Volunteers |
| Civic | Fraternal | Recreation | Women |
| Collectors | Health and Exercise | Religion | Workshops |
| Community | Historical | Scholarships | Youth |
| Computers | Hobbies | Senior Citizens |
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 B.M.Buss, Fairfield Public Library, 1080 Old Post Road, Fairfield, CT 06824.
04/15/2009