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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.

 

Last modified onThursday, 17 December 2015 21:21
More in this category: « Friends of the NIDL FORM
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