Library Card Registration Form
Ms. Mrs. Mr.
Last Name
First Name Initial
Address
Telephone:
Home
Work
Fax:
Email Address
Type of Card: Adult Young Adult Child
Your answers to the following questions will help us to serve you better. Answering them is optional. Your answers will be held in the strictest confidence.
Are you: Male Female What is your year of birth?
| What is your occupation?: | If a student, what level? | ||
| Business | Elementary (Parent must sign) | ||
| Professional | Junior High | ||
| Trade | Senior High | ||
| Homemaker | College Post College | ||
| Retired | Vocational/Technical | ||
| Service-Related | College, Part time |
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© Simsbury Public Library, 1996 - 2005.