Library Card Number *

Password *

First Name *

Last Name *

Middle Name

Mailing Address *

City *

State *

Zip *

If mailing address is a box number, please provide street address:

Street Address

City

State

Zip

Email *

Phone Number *

Alternate Phone Number

Birthday (MM/DD/YYYY)*

If you are under the age of 18, please provide the name of a parent or guardian:

Parent/Guardian Last Name

Parent/Guardian First Name

Parent/Guardian Middle Name

List all people who can pick up items for you *

Library I use most * -- Select a library -- Airway Heights Argonne The BookEnd Cheney Deer Park Fairfield Medical Lake Moran Prairie North Spokane Otis Orchards Spokane Valley

Enter code *

By submitting this form, you agree to the following:

The name, address, and all other information provided on this application are true and correct. I agree -

• To follow all rules and regulations regarding use of my library card.
• To pay all fines, costs, or fees assessed by the District for overdue, lost, or damaged materials.
• That I am responsible for all materials checked out with my library card, with or without my consent, and for all other uses of the card.

I understand that -

• My library card allows me to borrow materials, access Web site services, and use library Internet computers, software stations, and other library card-based services that may be made available.
• Failure to follow rules and regulations regarding use of my library card may result in suspension of library privileges.
• If fines, costs, or fees are not paid in a timely manner, my account may be referred to a collection agency and I will be responsible for any and all additional costs, including recovery fees permitted by state law and reasonable attorney's fees.