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<br />S}I1Item Membership Application Form <br /> <br />Authorization to Apply for New or Continuing System Membership <br />LIBRARY NAME: <br /> <br />CITY <br /> <br />This Authorization for application should be completed only for the following reasons: <br /> <br />. Your library is applying for new membership in the Texas Library System. <br />. Your library wishes to continue its membership in the Texas Library System for the upcoming state fiscal year (SFY2005 <br /> <br />All signatures are necessary, Current members of the Texas Library System MUST obtain all necessary signatures if they wi, <br />to continue their System membership during SFY2005. <br /> <br />Signatures of city secretaries, county clerks, and so forth are not valid substitutions for the signatures of mayors, city manager <br />or county judges. <br />IF you are unable to obtain all necessary signatures before this form is due at the State Library, THEN send the State Library al <br />other pages except this Authorization and indicate approximately when the Authorization for Application will be forthcoming <br />After obtaining the required signatures, mail this page to the Texas State Library at your earliest convenience. <br /> <br />By signing this fonn. the applying library is certifying that the infonnat/on presented in its <br />Annual Reporrfor Local Fisèal Year 2003 is complete and accurate. <br /> <br />AUTHORIZATION <br /> <br />SIGNATURE of Mayor, City Manager, or County Judge, or <br />School Superintendent (Circle applicable one) <br /> <br />Typewritten or printed name <br /> <br />SIGNATURE of Head Librarian <br /> <br />Typewrillen or printed name <br /> <br />SIGNATURE of Library Board Chair <br /> <br />Typewritten or printed name <br /> <br />Page 20 of22 <br />