Pollard Memorial Library - Library Card Registration Form

Please Print this page, fill out, and bring to the Pollard Memorial Library with proof of name and current Lowell address.

Name: First________________________MI________Last______________________________

Address: : Number & Street_____________________________________Apt#______________

City________________________________State____________Zip_____________________

Phone Number: (Include area code) ____________________________________________

Date of Birth: (MM/DD/YYYY) _______________________________________________

Circle One From Each of the Categories Below:

1. Female

2. Male

Neighborhood or Residence:

1. Acre	4. Centralville	7. Pawtucketville
2. Ayer City	5. Downtown	8. South Lowell
3. Belvidere	6. Highlands	9. Other

Birth Year Ranges:

1. -- 1922	4. 1959-1965	7. 1988-1998
2. 1923-1948	5. 1966-1976	8. 1999 or later
3. 1949-1958	6. 1977-1987	9. No response

E-mail address (PRINT): ____________________________________________________
N.B. If you choose to be notified by e-mail, no paper copies will be mailed.

Ask us about "PIN" numbers.

Would you like to receive information about Library programs and events (Yes or No)

By Mail _________
By E-mail _________

Pollard Library Home Page

By the PML Web Committee
Last updated June 3, 2005.
http://www.pollardml.org/librarycard.html
Send comments to mloref@mailserv.mvlc.lib.ma.us