MEMBERSHIP RECORD


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Card Number:
Postal Address: ,
Home Address: ,
Phone (Home):
Phone (Daytime):
Fax:
E-mail: ">
Textmessaging:

Membership Number:
Membership:
Area:
Fee:$30/year, Paid
Joined: , Expires:
Joining Branch:

Ethnicity: ,
DoB:
Sex:

Alternative Contact:
Phone:
Relationship:
Notes:

Guarantees:">
 Guarantor: ">
no guarantor

General Notes:

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FINES & CHARGES
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ITEMS CURRENTLY ON ISSUE
Title Due Itemtype Charge Renew
&bib=&bi="> ">On Request - no renewals " value=y>Y " value=n>N

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ITEMS REQUESTED
Title Requested Remove
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