Which service are you requesting? Library by Mail District residents who cannot visit the Library due to a temporary or permanent condition Special Delivery New or expecting parents unable to make it to the Library Name First Name Last Name Address Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone Number Email Address Date of Birth: Please enter your library barcode here: I do not have a library card, and I am requesting an application: Yes No Reading Preference Historical Fiction Horror Mysteries Romance Science Fiction/Fantasy Thrillers and Suspense None Other… Enter other… What type of non-fiction do you like? Biography and Memoir Cookbooks Crafts Health History Nature and Science Sports Society and Culture Television/Theater/Film Travel True Crime None Other… Enter other… Do you want to read or listen to a book? Read Read, large type Listen, book on CD Listen, playaway Other… Enter other… How many items would you like to receive? 1 - 3 4 - 6 6 - 10 List some books and authors that you have enjoyed. Are there types of books or authors you do not want to receive? Is there anything else you would like to tell us about your reading preferences? I do not wish to receive materials that contain (check all that apply): Strong Language Violence Explicit depictions of sex Do you have a computer with internet access at home? Yes No Would you like a demonstration on how to access materials to read or view online? Yes No Children's Books Children's Books Composite Information message How many children are you requesting books for?(max 4) Add Do you give the library permission to authorize a member of the Lindenhurst Memorial Library to use your library card to check out materials for you? Yes No Signature CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
