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Temporary SMRLD Library Card Registration Form
This is for taxpaying residents of the Six Mile Regional Library District (anyone living in 62040).

A photo ID will be required on your next visit to the Library, either 2001 Delmar Avenue or 2145 Johnson Road. Your membership will be deactivated eight weeks from today if you are unable to make it to either location with a photo ID that shows your current address. Please allow 48 hours for a library card to be assigned to you.
Last Name *
Your answer
First Name *
Your answer
Middle Initial
Your answer
Date of Birth *
MM
/
DD
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YYYY
Home Address *
Your answer
City *
Home Phone Number
Go to the next question if you don't have a landline.
Your answer
Cell Phone Number
Your answer
Cell Phone Carrier
Who supplies your cell phone's service? AT&T, Verizon, T-Mobile, Sprint, Spectrum, etc. This allows us to send you text message notifications if you opt-in below.
Your answer
Email address *
Your answer
How would you prefer to be contacted by the Library? You may choose more than one. *
This is primarily for how we will contact you to notify your of your library card number as well as when items that are ready to be picked up. We will not share your personal information and will only contact you for item pickup or absolutely necessary communications.
Would you like to receive Library information via email? *
We can send you emails that include what's new at the Library, program information, etc.
Driver's License or State ID Number *
Please enter your Illinois Driver's License or State ID number.
Your answer
Statement and Signature *
Typing your full name below serves as your signature and verifies that you agree to the following statement: I understand that I am responsible for all use of my library card. I agree to comply with all the rules of the public library; to pay promptly all fines for overdue, damaged, or lost materials; and to give immediate notice of any change of address or lost card. I understand that the Internet-access terminals are not located in private rooms, and I waive any claim to confidentiality or privacy arising out of or involving use of the Internet through the Library.
Your answer
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