Home Connections Application

Name(Required)

First Last

Phone(Required)

Email(Required)

Library Card Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Which library service would you like?(Required)

Mail service (Limit of 10 items per month).

Flexible check-out. The person(s) listed below are authorized to pick up books for me.

Name

First Last

Name

First Last

How do you want materials selected for you? Check one (1)(Required)

Request Only: I want to make my own selections and call. place a request in the library catalogue, or email the library when I want something sent.

Readers’ Advisory: I want the library staff to make selections for me.

What kind of materials do you want to receive?

I want print books.

I read only Large Print.

I prefer Large Print but will accept regular print to fill my title requests.

I want audio books – Compact Disc (CD).

I want paperback books only.

Tell us your favorite authors and any special interests.