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Library Card Application

2. Last Name*

3. First Name*

4. Middle Initial

6. Street Address*

8. City

9. Zip Code

11. Sex*

    1. Male
    2. Female

12. Birthdate*
    Birthdate

    Applicant must be at least 13 years old. Parents may not use the online application to register for a child aged 12 or under.

14. Email Address*

15. Telephone Number (with Area Code)*

17. How would you like to be notified of available holds on your library account?*

    1. Phone
    2. Email

19. Would you like to be added to our library's email newsletter of upcoming library events?*

    1. Yes
    2. No

21. I am age 13 or older. *

    1. I agree.

23. I am a current resident of the City of Moline and can provide proof of residency (license or photo ID with current address OR photo ID and mail, FOID, voter's registration with correct address)*

    1. I agree.
25. My card will not be eligible for use until received in the mail and photo ID is presented to verify my identity and address prior to first use. *

    1. I agree.
27. It may take up to 10 business days to receive my library card in the mail.*

    1. I agree.
29. I will obey all rules and regulations of the Library, pay fines for any lost or damaged items borrowed on my card, and give immediate notice of change of address. *

    1. I agree.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field