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eLibrary Card Application

2. 

4. First Name:*

5. Middle Initial:*

7. Last Name:*

9. Date of Birth:*

11. Address:*

13. City*

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

15. Zip*

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

19. Email:*

20. Phone:*

    xxx-xxx-xxxx

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

    Choose the location you'd like to pick up your physical library card. Cards will be valid for 90 days until picking up. When you pick up your card staff will transition it to a permanent card. Must have valid ID with current address to pick up.

24. 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:*

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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