PATRON REGISTRATION FORM                  Date__________

Name:________________________________________________
          First                         Middle                              Last

Street:_________________________________________________

City:________________   State:_________  Zip Code:____________

Phone:______________  Business Phone:_______________________

E-Mail Address:______________________@__________________

Signature:________________________________________________

Parent/Guardian Signature:____________________________________
(If Under Grade 9)

Your signature indicates compliance with all policies of the Billerica Public Library. Copies of these policies are available upon request. Please return this form to the library with proof of residency to obtain card.