LAST NAME
                                                     
FIRST NAME MIDDLE NAME
                                                   
MAILING ADDRESS
                                                     
CITY STATE ZIP
                                                 
GUARDIAN'S NAME (IF UNDER 15)
                                                     
HOME PHONE ADDITIONAL PHONE
            -                     -        
E-MAIL ADDRESS
                                                     
*Your library card is good at any branch of the Maury County Public Library.  It is free to all residents of Maury County and is available to non-residents for an annual fee.
*Your library card is for your own personal use.  You are responsible for all materials borrowed on the card.  Lost or damaged items must be paid for.  Report lost or stolen cards immediately to prevent unauthorized use.  Replacement cards: $5.00.
*The library charges fines for materials kept past the due date ($0.20 per day per item), and reserves the right to refuse further service until overdue materials are returned and account balances paid.
*Please report changes of name, address, or telephone immediately.
My signature below indicates that I agree to comply with the library regulations:
                                                 
APPLICANT SIGNATURE OR PARENT/GUARDIAN SIGNATURE (IF UNDER AGE 15)
                                                     
For Library Use Only
Date                 Staff Initials