Joint Les Cheneaux/LSSU Library card registration

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Contact LSSU

Use this form to joint register a patron with Les Cheneaux Public Library only.

Please complete the form below

"*" indicates required fields

Name**

First Last

Email**

Township: **

County **

Birth Date**

Age group: *

Required – Include PO Box if applicable

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Local home phone #: **

Alternate phone #:

(optional)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Perm Home phone #:

Perm. Alternate phone #:

Bayliss barcode #

Someone in the area we can contact if we can’t reach you.

Reference Full Name: **

Reference phone: **

Reference Address: *

Patron has signed paper registration form? *

If a minor, has parent/guardian signed the paper registration form?

Barcode #: **

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Kenneth J. Shouldice Library