HLS Join Up Form

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* 1. Are you completing this form on behalf of the applicant? If so, what is your relationship?

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* 2. Name

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* 3. Library Card no.

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* 4. Date of Birth

Date

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* 5. Email Address

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* 6. Phone Number

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* 7. Street Address

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* 8. Suburb

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* 9. Next of Kin/Emergency contact (and relationship)

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* 10. Next of Kin/Emergency contact - Phone number

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* 11. Are you interested in books in languages other than English?

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* 12. Fiction reading preferences: What do you like to read, listen to or watch? (check all that apply)

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* 13. Non-Fiction (true stories) reading preferences: What do you like to read, listen to or watch? (check all that apply)

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* 14. What is your preferred format? (Tick all that apply)

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* 15. Please tell us about books, DVD's, magazines, music or subjects that you have enjoyed.

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* 16. Which books, DVD's, magazines, music or subjects have you NOT enjoyed.

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* 17. How many items?

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* 18. How often would like a delivery?

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* 19. Please provide access information and any other details.

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* 20. Does the applicant give permission for volunteers/staff of MidCoast Council Libraries to enter their property for the delivery of library Items?

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