Title   Mr Mrs Miss Ms Master Dr Prof  First Name(s) *  Last Name *

Your Date of Birth *  --Day-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   --Month-- January February March April May June July August September October November December   Year

Gender *  --Select-- Male Female

 

Your home telephone number

Your work telephone number

Your mobile telephone number

Your email address

 

 

 

 

At which library do you wish to register?

Select from the list  Accrington Adlington Ansdell Bacup Bamber Bridge Barnoldswick Barrowford Bolton-le-Sands Briercliffe Brierfield Burnley Burnley Campus Burscough Carnforth Caton Community Library Trust Chatburn Chatsworth Chipping Rural Library Service Chorley Clayton Green Clayton-le-Moors Cleveleys Clitheroe Coal Clough Colne Coppull Crawshawbooth Dolphinholme Rural Library Service Dunsop Bridge Rural Library Service Earby Eccleston Euxton Fleetwood Freckleton Fulwood Garstang Great Harwood Halton Haslingden Heysham Ingol Kingsfold Kirkham Knott End Lancaster Leyland Longridge Longton Lostock Hall Lytham Mellor Morecambe Nelson Ormskirk Oswaldtwistle Padiham Parbold Penwortham Pike Hill Poulton Preston Harris Rawtenstall Read Ribbleton Rishton Rosegrove Savick Sharoe Green Silverdale Skelmersdale St Annes Tarleton Thornton Trawden Upholland Whalley Wheatley Lane Whitworth

This is for administrative purposes only - once you receive your card, you can use it at any library.

Equal Opportunities Monitoring

Lancashire County Council are committed to promoting access to services for all. To help us monitor the effectiveness of our library service and develop our services to meet your needs, we ask you to complete the section below.

Disability

Select any that apply from the list.

Visual Impairment Deaf/Deafened Hard of Hearing

Learning Disability Physical Disability Mental Health Difficulties

 

Ethnic Origin

Select from the list.

--Select-- Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Any Other Asian Background Black or Black British - Caribbean Black or Black British - African Black or Black British - Any Other Black Background Chinese Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Any Other Mixed Background Other Ethnic Group e.g. Traveller, Romany White - British White - Irish American Australian Canadian Czech French German Latvian Polish Portuguese Russian Slovakian Other Declined Unknown

Communications

By joining the library, I agree to

• Bring back what I borrow, on time and in good condition
• Treat library staff, customers and property with respect and consideration
• Observe the Computer Usage Rules, Library Byelaws and Regulations
• I understand that if I do not, I may not be able to use the library

We may contact you from time to time by post, e-mail or telephone to give you information about our library events and services.  Please check this box if you do not wish to receive these messages from the library.

Data Protection Act 1998: The information on this form will be kept and used in the County Library Computer Systems under the terms of the DPA 1998 and will only be used in connection with the operation of the library and information service. In case of query please contact the nominated LCC Data Protection Officer at PO Box 100, County Hall, Preston PR1 8RJ