Name:

Mailing Address:
City: State: Zip Code:

Phone: Work Phone:

ID: (One of the following)

NC D.L.
Soc. Sec # (Optional):
(A child may use his parent's driver's license for I.D.)

Birthday :

Non-Resident Permanant Address:

Mailing Address:
City: State: Zip Code:

Signature of Applicant: _____________________________________________________________

Parent/ Guardian Signature (Under 16): _________________________________________________

This information is protected by North Carolina Statutes (Chapter 125-19) and will be used only for library statistics and planning.

You must present your card to check out materials. If you lose it, there is a replacement cost of $2.00