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NIDL Forms

NIDL Forms (2)

These are forms to use when contacting NIDL...

NIDL Forms

NIDL REGISTRATION FORM

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NIDL REGISTRATION FORM 7/10

LAST NAME:                                      FIRST NAME:
ADDRESS:                                         BIRTHDATE:        /       /
CITY:                                                  PHONE #:
STATE:                                      ALT. PHONE #:
ZIP CODE:                                          E-MAIL:
I hereby sign and agree to obey the rules of the Northeast Indiana Diversity Library.                                 
SIGNATURE:                                      REG. DATE:       /      /

 

**Staff Note: “New” patrons may checkout only two items; enter in the “Card Expires” on their computer patron record one month after the above “REGISTRATION DATE:” on this form.
1st ID:                                                      2ND ID:
Staff Initials:                                          PATRON #:

 

Print by right clicking on form, select "Print", change layout to "Landscape", and print just page 2.

 

Friends of the NIDL FORM

Print this form by right clicking on form, select "Print",

change layout to "Portrait", and print just page 3.

 

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Yes, I want to help support N.I.D.L. with a financial contribution as a Friend!

NAME                                                                                           

ADDRESS                                                                                     

CITY                                                STATE             ZIP                 

E-MAIL                                                                                         

FOR PROFESSIONALS

BUSINESS NAME                                                                           

BUSINESS E-MAIL*                                                                       

*If e-mail is different from personal

BUSINESS PHONE                                                                          

AMOUNT OF SUPPORT

[ ] $25   [ ] $50   [ ] $75   [ ] $100   [ ] Other                   

IF BY PAYPAL PLEASE ADD THE DATE OF TRANSACTION     /     /    

[  ] YES, Please contact me on all events and speakers that NIDL supports.

Your contributions may be tax deductible.

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