Member#
, Card Number*
MEMBER PERSONAL DETAILS
*
checked>F
checked>
Date of Birth
(dd/mm/yy)
No Title
>
Title
Initials
Given Names*
Surname*
Prefered Name
>
Ethnicity
Ethnicity Notes
Membership Category*
MEMBER ADDRESS
>
-
Postal Address*
Town*
Area
Street Address if different
Town
MEMBER CONTACT DETAILS
Phone (Home)
Phone (day)
Fax
Email
ALTERNATE CONTACT DETAILS
>
Name*
Phone
Relationship*
Notes
LIBRARY USE
Notes
FLAGS
>Yes
>No