Home Delivery Registration

Name *

First

Last

Delivery Address *

Date of Birth (enter only numbers below) *

Phone Number (enter only numbers below) *

Email *

Email

Confirm Email

Library Card Number

Please Respond to the following: *

I would like to pick out my own items on the catalogue and will place them on hold online or call.
I would like to call the library with a list of items to be delivered if possible.
I would like to pick out some of my own items to place on hold and have the librarian pick out the rest.
I would like the librarian to pick out all my items.

I am interested in receiving:

(check any that apply)

The print size I prefer

(check all that apply)

I would like:

(check all that apply)

I enjoy DVDs that are:

(check all that apply)

I enjoy CDs that are:

I enjoy books that are:

Other (please specify)

Magazines (please specify)

I enjoy books written by:

Additional Comments:

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