Public Libraries Section Request for Support

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* 1. Your Information

Name

Phone Number

Email

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* 2. Organization Information

Name

Phone Number

Website

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* 3. Purpose of Request

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* 4. Total budget for event/activity funded

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* 5. Amount requested from NYLA PLS

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* 6. Have you received support from NYLA PLS in the past 5 years?

Yes

No

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* 7. Are you/your organization a NYLA member?

Yes

No