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PCPL Member Registration Form

2. Thank you for your interest in becoming a member of the Powhatan County Public Library.
4. Patron Information

   1. Adult
   2. Juvenile (under 18)
5. Powhatan County Employee

   1. Yes
   2. No
7. First Name*
8. Middle Name
9. Last Name*
10. Date of Birth*
    Date of Birth
12. Mailing Address*
13. City*
14. Zip Code*
16. Primary Phone Number*
17. Email Address*
19. I would like to receive hold notices & courtesy overdue notices by:

    1. Email

    1. Phone
21. Wowbrary

    Once a week Wowbrary will email PCPL patrons with the newest bestsellers, DVDs, books and audiobooks. Wowbray is a free service provided by PCPL.

    1. Do not send me emails about new books, DVDs and audiobooks in the library.
23. Statement of responsibility

    I accept responsibility for all materials borrower, fines charged, and any loss or damage, whether intentional or unintentional, to library property, including public use computers or any related hardware or software provided by the library.

    
    For a youth/juvenile card, I accept all responsibility for the materials borrowed by my child. I understand that overdue items on a juvenile's card may affect the status of the adult's card and the cards of other juveniles for which the adult has co-signed.

25. Electronic Signature
27. Please allow 5-7 business days for online card processing. If you need your card sooner, please visit the Library to complete a print application.
Leave This Blank:


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

    This field is not part of the form submission.

31. Submit

* indicates a required field