Southworth Library Card Application

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Please complete this form to the best of your abilities and then come to the library to pick up your new library card! When you come to the library, please make sure to bring in valid proof of address (driver's license, piece of mail, utility bill, lease agreement, property tax receipt, voter registration card).

Date

YYYY

Name (Last, First, M.I.) *

Mailing Address *

City *

County *

Zip Code *

Phone # with area code

Cell #

Birthdate (MM/DD/YYYY) *

School District *

Email address *

Preferred notification option [Note: please make sure you have provided your preferred email address or phone number above for notifications] *

Phone

Do you have other Fingerlakes Library System cards? *

Yes

Submit

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