Library Membership Application

First name*

Last Name*

Phone Number*

Email*

Your Street Address + Postal Code*

I am: *

under the age of 14an adult over the age of 14

I am: *

getting a new library cardrenewing my library card

Please enter your date of birth

Municipality*

Choose your pick up location*

AlmontePakenham

I consent to allow Mississippi Mills Public Library to use my email address to send me ( you might change your permissions at any time by contacting the library):*

information about my library account (items ready for pick up, overdue, etc.)library newsletter

Attach proof of identity / proof of residence*

Fine Print:

By filling out this form, I understand and agree to follow the patron code of conduct. If I am under the age of 14, my parent/guardian understands and agrees that they are responsible for my use of the library.

I hereby apply for membership to the Mississippi Mills Public Library, which includes online services and borrowing privileges. I (or my parent/guardian) agree(s) to be responsible for any materials borrowed on my library card and to abide by the rules and regulations of the Mississippi Mills Public Library.

Personal information on this form is collected under the authority of the Municipal Act, RSO 1980, c.302 (as amended). It is used to maintain an official record of library users, to notify users of important information about their accounts, to prepare statistical reports, and to plan the provision of library services.

Library Card Application