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Winooski Memorial Library Card Form

2. First Name*

3. Last Name*

4. Email Address*

6. Address*

7. Apartment Number

9. City*

10. State*

11. Zip Code*

13. Phone Number

15. Disclaimer
    I am responsible for all items borrowed with the library card issued in my name, unless I have reported the loss of my library card. I promise to comply with all library rules and policies both present and future, and to give prompt notice of change of address, phone number, or loss of library card.

    I am responsible for all items borrowed with the library card issued in my name, unless I have reported the loss of my library card. I promise to comply with all library rules and policies both present and future, and to give prompt notice of change of address, phone number, or loss of library card.

17. Agreement*

    1. Yes

    By clicking yes, I hereby electronically sign this document and agree to the disclaimer above.

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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field