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__________________________________________________