Libraries - joining form

Shire Hall, Castle Hill, Cambridge, CB3 0AP : Phone 01223 717111 (Main switchboard), 0845 045 5200 (Cambs Direct)

Part 1- Main Details
Title:	Mr Mrs Miss Ms
	Other (please state)

Family name/ Surname: (required)

First name(s): (required)

Address: (required)



Town/City: (required)

Postcode: (required)

Telephone:

Date of Birth: (required)

Email: (required)	Note: If you give us your email address we will use it to send notices of requests and overdues. If your email address is shared, these notifications cannot be kept private.

	Note: We may use email to send you information about new services. Click this box if you DO NOT want us to use your email for this purpose. No

Please choose a 4 digit number for your PIN.	Note: This will enable you to access your online account from home and computers in the library.

Do you live permanently in Cambridgeshire:	Yes No

Part 2- For those not living permanently in Cambridgeshire
Address: (required)



Town/City: (required)

Postcode: (required)

Telephone:

Date you will leave Cambridgeshire.

Name of company/ organisation/ college/ school/ hostel.

Part 3- To join additional children under 16
First Child

Family name/ last name:
First name:
Date of birth:

Second Child

Family name/ last name:
First name:
Date of birth:

Third Child

Family name/ last name:
First name:
Date of birth:

Part 4- Details of a parent / guardian for those under the age of 16.
(Where Part 1 has been completed by a person under 16)

Name of parent / guardian:

Contact address:



Town

Postcode:

Part 5- Complete this section to help us provide the library services you need for members of your family (optional)
Access services
Are you registerd blind / partially sighted?	Yes No

Are you housebound?	Yes No

Do you have a disability?	Yes No
if yes please specify

Ethnic origin:

Part 1- Main Details