Library Card Application

2. Please fill out this application completely. Your Library card will be available on the next business day at the location you specify below.

4. First Name*

5. Last Name*

6. Middle Initial*

8. Mailing Address*

10. City*

11. State*

12. Zip Code*

14. Physical Address

16. Email Address

17. Home Phone*

19. Work Phone

20. Mobile Phone

22. Voting District
    -- Select One --AbingdonGloucester PointPetsworthWareYork

23. Date of Birth*

24. If you are under 18 years old, enter your Parent or Guardian's full name

26. List your children's full name(s) who are under 18 that you would like to receive a Library Card

28. Select a Library Card
    -- Select One --Paper Card - FreePlastic Card (Credit Card Size) - $1 donation to FriendsPlastic Card (For Key Chain) - $1 donation to Friends

30. Paper Card

    

31. Plastic Credit Card

    

32. Plastic Key Chain Card

    

34. Where do you wish to pickup your Library Card?*
    -- Select One --Main LibraryPoint Library

35. I give permission for others (family members, neighbors) to check out items reserved for me.*
    -- Select One --YesNo

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field