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2. Name*

   Last name, First name

3. Telephone*
5. Mailing Address*

   Street Address or P.O. Box

7. City*
8. State*
9. Zip Code*
11. Email address
13. Preferred method of notification*
    -- Select One --TextEmailTelephone call

    Please indicate how you wish to be notified for almost due, overdue, and/or reserved items.

15. Agreement*

    By checking this box, I am indicating that I will be responsible and will pay the Smithville Public Library for any damages to books, loss of books, and for the fines due on books.

    1. I agree
16. Date completed*
    Date completed
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field