Donor name _____________________________________________________________

Phone _________________________________________________________________

_______Please purchase my favorite book, title and author listed below

Title __________________________________________________________________

Author ________________________________________________________________

_______Please purchase a book of your choice for me

Book Plate Information

Donated by _____________________________________________________________

Dedicated to ____________________________________________________________
                                                ex. - dedicated to the memory of ---------

______Please notify the recipient of this dedication

Name _________________________________________________________________

Address _______________________________________________________________

             ________________________________________________________________

Please send to Mary Bray School, attn. Media Center along with cash or check for $20.00 made out to Mt. Ephraim Public Schools.  Thank you for supporting our school library!