Application form for the Lucis Trust library in New York

Name:

Street:
   City:
State:
   Zip:

Telephone number

Home:
   Business:

E-mail address:

Is the above your permanent address? If not, please state permanent address:

Street:
   City:
State:
   Zip:

How did your hear of the Lucis Trust?

Please supply the name of two references (friends or family) who can be reached at addresses other than your own.
(Applications not accepted without this information.)

Name:

Street:
   City:
State:
   Zip:
 

Name:

Street:
   City:
State:
   Zip:

I accept the library rules and procedures enclosed with this application and agree to abide by them.