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CWC Library Card Application Form
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Initial
*
Your answer
Last Name
*
Your answer
CWC ID # (7 digits)
*
Your answer
Date of birth
*
Your answer
Library Barcode # (on back of CWC ID)
*
Your answer
CWC Affiliation
*
CWC Student
CWC Staff/Faculty
CWC email address
Your answer
Cell Phone number
*
Your answer
Alternate phone number
*
Your answer
Local mailing address: line 1
*
Your answer
Local mailing address: line 2
Your answer
Local mailing address: City
*
Your answer
Local mailing address: State
*
Your answer
Local mailing address: Zip/postal code
*
Your answer
Please enter your full name as your digital signature that you will be responsible for all materials checked out on your library card:
*
Your answer
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