| Name | ||||
| Address | ||||
| Phone/Email | ||||
| Library Card Number | ||||
| Preferred Reading Format ( Please Check) | ||||
Audio Books |
Large Print |
Regular Print |
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| Do you want magazines? | Do you want movies? | |||
| Day(s) of the week you will be home for pick-up and delivery? Monday Tuesday Wednesday Thursday Friday |
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Type of books you are interested in?
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