New Patron Signup Form
Please fill out this form completely and press the submit button once. After your information is reviewed, you will be added to the system and allowed to check out items from the library.
Full Name:
(ex: Jane Doe)
E-Mail:
(ex: a348@cs.indiana.edu)
Street Address:
(ex: 100 North Indiana Avenue)
City:
(ex: Bloomington)
Zip Code:
Enter in the format ##### (ex: 47401).
Telephone Number:
Enter in the format ###-###-#### (ex: 812-555-1212).
Gender:
Male
Female
Date of Birth:
January
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Username:
No more than 20 characters (ex: billg)
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