Library Card Form - 14 years and older | Annapolis Valley Regional Library

First Name: *

Middle Name: *

Last Name: *

Preferred Name:

Birth Date *

Month

Day

Year

Mailing Address: *

City: *

Province - Nova Scotia Only *

Postal Code: *

Telephone number where you prefer to be contacted (10 digits required):) *

Another Telephone Number, if desired:

Email Address:

NOTE: by providing an e-mail address, you are granting permission for your personal library information to be communicated to this address. (Example: notices about loaned material).

If you would like to sign up for our monthly emailed newsletter, please check the box below:

Municipal unit of residence, please choose one: *

If you are a seasonal resident, please provide your other mailing address (for mail out notices, etc.): Civic/Mailing Address:

City:

Province:

Postal Code:

The location where you would prefer to pick up material, please choose one: *

I, (enter name below), *

agree to take responsibility for materials borrowed on this card and to abide by the rules and regulations of the Regional Library.

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Library Card Form - 14 years and older