Adult Non-University Borrowers' Card Application

Note: Please read "Adult Non-University Borrowers' Guidelines" before completing this application. The fields preceded by an * are required.
Borrower Information
First Name:	*
Middle Name or Initial:
Last Name:	*
Address:	*
City:	*
State:	Kentucky
Zip Code:	*
Phone:	*
E-mail Address:
Drivers License Number:	*
Agreement/Authorization
I have read a copy of Eastern Kentucky University Libraries Guide for Adult Non-University Borrowers and agree to comply with these policies.
In order to have your application approved you must bring your signed application to the Circulation Desk. If you have any questions please consult with Judy Warren at the Circulation Desk.
____________________________________ Date	____________________________________ Signature

URL: http://www.library.eku.edu/patron/adultcard.php web.library@eku.edu

Last modified: July 24, 2007 | 12:25:16 Validation: CSS | W3C