Library Card Application

First name

Last name

Street Address

Barkhamsted Colebrook Winsted/Winchester

Zip Code

Primary Phone

Email address

Are you 18 years old or older: Yes     No

If you answered "No" above, please indicate your date of birth:   (month/date/year)

I would like to receive my new library card:
By mail I will come pick it up at the library

I hereby apply for the right to use the Beardsley & Memorial Library, and agree to comply with all its rules and regulations, to pay all fines, to make good any loss or injury to materials incurred by me and to give immediate notice of any changes of residence. If my overdue books are not returned, the Library has the right to forward my account to a collection agency.