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)
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