Non-participation form
(*)Indicates a required field
Select Your Library (*)
Please make a selection
Contact Name (*)
Please enter your name
Contact Email Address (*)
Please enter your email address
Select this button to indicate that you do not plan to participate in the 2015 Summer Library Program (*)
Please select the radio button.
Non-participation in the Summer Library Program results in a loss of $200 from your CKLS incentive grant.
Submitting this form constitutes your electronic signature indicating you do not plan to participate in the 2015 Summer Library Program.
Enter the CAPTCHA code. (*) Enter the CAPTCHA code.
  Refresh
Please type the four jumbled letters you see above the text box. (This is called the CAPTCHA code.)
 
Joomla Template: by JoomlaShack