INDIAN RIVER COUNTY LIBRARY SYSTEM
Card Registration
6 mos._________
Non. Res.________
Res.________
FIRST NAME
MIDDLE INITIAL
LAST NAME
Ms.
Miss
Mrs.
Mr._________________________________________________________________________________________________
BARCODE
CATEGORY
______________________________
______________________________
BIRTHDATE
____/____/____
MAILING ADDRESS
_______________________________
CITY
_______________________________
STATE / ZIP
_______________________________
HOME PHONE
_______________________________
WORK PHONE
_______________________________
How should we send you notices?
____ MAIL
____ EMAIL
PERMANENT ADDRESS
_______________________________
CITY
_______________________________
STATE / ZIP
_______________________________
PHONE
_______________________________
EMAIL ADDRESS
_______________________________
Do you want your record to include
a history of what you've checked out?
____ YES
____ NO
One proof of Indian River County Residency or Property Ownership Required:
Driver's License (Parents__)
_______________________________
Vehicle Registration (IRC)
_______________________________
IRC Property Deed or Tax Record
_______________________________
IRC Property Lease (min. 6 mos.)
_______________________________
IRC Voter's Registration
_______________________________
IRC School ID / College ID
_______________________________
IRC School Teacher ID
_______________________________
Other
_______________________________
I AGREE TO:
OBEY ALL LIBRARY RULES, PAY FOR ALL LOSS OR DAMAGE TO LIBRARY
MATERIALS, AND GIVE IMMEDIATE NOTIFICATION OF CHANGE OF ADDRESS
OR LOSS OF MY LIBRARY CARD.
DATE:_____________________ SIGNATURE:____________________________________________
IF YOU ARE
UNDER 18
, GIVE NAME OF PARENT OR GUARDIAN:_____________________________
PARENT OR GUARDIAN'S SIGNATURE__________________________________________________