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eLibrary Card Application

2. 

3. After you fill out this form and we have contacted you come to the library, complete an application via curbside or fill out a form online. Please bring your photo ID that includes your current address (or a photo ID with a non-current address with a check, bank statement, utility bill, etc. that lists your current address). If you filled out the online form, we will ask for you to sign your application when you arrive. Your library card will be issued immediately and is yours to use at any of the public libraries in the Roanoke Valley.

   After you fill out this form and we have contacted you come to the library, complete an application via curbside or fill out a form online. Please bring your photo ID that includes your current address (or a photo ID with a non-current address with a check, bank statement, utility bill, etc. that lists your current address). If you filled out the online form, we will ask for you to sign your application when you arrive. Your library card will be issued immediately and is yours to use at any of the public libraries in the Roanoke Valley.

5. First Name:*

6. Middle Initial:*

8. Last Name:*

10. Date of Birth:*

12. Address:*

14. City*

15. States:*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming

16. Zip*

18. Resident of:*
    -- Select One --Botetourt CountyCity of RoanokeRoanoke CountyCity of Salem

20. Email:*

21. Phone:*

    xxx-xxx-xxxx

23. Home Library Location*
    -- Select One --Bent MountainGlenvarHollinsMt. PleasantSouth CountyVinton

    Choose the location you'd like to pick up your physical library card. Must have valid ID with current address to pick up. Staff will email you.

25. I accept responsibility for all materials borrowed on this card and agree to abide by the policies of the Roanoke Valley Libraries. These policies include paying for lost or damaged items, all overdue fines and giving immediate notice of card loss or change of address.

    I accept responsibility for all materials borrowed on this card and agree to abide by the policies of the Roanoke Valley Libraries. These policies include paying for lost or damaged items, all overdue fines and giving immediate notice of card loss or change of address.

26. Initials:*

Leave This Blank:


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

    This field is not part of the form submission.

30. Submit

* indicates a required field