*1.Full name, including middle initial:(Required.)

*2.Age Group(Required.)

0-12

13-17

18+

*3.Gender(Required.)

Male

Female

Other

Prefer not to answer

*4.Physical mailing address:(Required.)

5.E-mail address:

*6.Phone number:(Required.)

7.School/college or place of employment:

8.If you would like to access our digital collection, like eBooks, you will need to select a 4-digit PIN number:

9.How would you like to receive your library card?

Pick up from Marksville Library

Mail it to my physical address

Other (please specify)