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LIBRARY CARD APPLICATION ADULT

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LIBRARY CARD APPLICATION ADULT Powered By Docstoc
					                                         LIBRARY CARD APPLICATION
PLEASE PRINT                                       ADULT
Full Name: _____________________________________________________________

Street Address: _________________________________________________________

City, State, ZIP: _________________________________________________________

Phone #: __________________                Is this your home or cell number? ______Home             _____ Cell

Birthdate: _______________________

Last 4 digits of Driver’s License # __________
 OR
Last 4 digits of Social Security # ___________

PIN #: _____________(Please choose any 4 digits to access your online account)

Email Address (optional): _________________________________

       _______Yes, I would like to receive emails about library information & events
       _______Yes, I would like to receive an email when items I request from Interlibrary Loan arrive
                                (Otherwise we will call you when your items are available)
               _______ Yes,   I would also like to receive an email 3 days before my items are due

A Helen Matthes Library Card entitles you to borrow materials from the Helen Matthes Library. By using the
card you agree to comply with all the rules and regulations of the Helen Matthes Library, including the Internet
rules, and to pay any and all overdue fines and charges for lost, stolen, or damaged materials. This also
applies to any Interlibrary Loan items that are requested and borrowed from other libraries whether they are
part of Rolling Prairie Library System or outside our system. Please report a lost or stolen card and any address
changes. The Helen Matthes Library is not responsible for the unauthorized use of the library card. Failure to
comply with the library rules may result in the suspension of borrowing privileges.

Signature: _________________________________________ Date: __________________________

Printed Name: __________________________________________________________

FOR STAFF USE ONLY:                   Initials: ______________      Date: _________________

Type of Card: _____RA _____RJ _____NA _____NJ _____Renewal _____Reciprocal**

Barcode:                                                         Expiration Date: ____________

**If reciprocal, home library number: _________________________

Paid by (if applicable): _____Cash _____Check
OPTIONAL

Please take a moment to help us meet the needs of our patrons by filling out this short survey.


Did someone refer you or influence you to get a library card? ___Yes ___No

				
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