Santa Rosa County Library System

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Please complete the form below. Make sure all text fields are answered. Type “none” if you do not have an alternate phone.

Please note: Requests for replacement cards cannot be processed using this form. Replacement cards are available at your local library for a cost of $5.

*First Name & Middle Initial:

*Last Name:

*Address:

*City:

State:

*Zip Code:

County:

*Home Phone:

Is Number Long Distance?

YES NO

Alternate Phone:

Is Number Long Distance?

YES NO

*Email Address: (Give parent
e-mail if under 18)

Library cards will be delivered via postal mail.

Are you a child under 18 years old? If so, you must provide your date of birth and the name of your parent or guardian.

Parent's Name

example: 11/02/2006

By selecting "Accept", I agree to abide by library borrowing policies and assume responsibility for all library materials including payment for materials not returned.

* I Accept

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