Member# , Card Number*
/images/background-mem.gif">MEMBER PERSONAL DETAILS			/images/background-mem.gif">* checked>F checked> M     Date of Birth ()
Title	Initials	Given Names*	Surname*	Prefered Name
value=" ">No Title >Miss >Mrs >Ms value="Mr" >Mr >Dr >Sir
Ethnicity		Ethnicity Notes						Membership Category*
>
/images/background-mem.gif">MEMBER ADDRESS
Postal Address*			Zipcode / Town*	Joining Branch
			">
Street Address if different			Zipcode / Town
			">
/images/background-mem.gif">MEMBER CONTACT DETAILS
Phone (Home)		Fax	Email	Text Messaging
Phone (Daytime)
/images/background-mem.gif">ALTERNATE CONTACT DETAILS
Name*			Phone	Relationship*
				>
Notes	<TMPL_VAR NAME=altnotes>
/images/background-mem.gif">LIBRARY USE
Notes	<TMPL_VAR NAME=borrowernotes>
FLAGS
		>Yes >No
	> //images/2rightarrow.png" ALT="Add New Member" border=0 >