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