Centuria Public Library
Centuria Public Library - Library Card Registration Form
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Last Name *
First Name *
Middle Name *
Parent/Guardian Name (if under 18) *
Street Address/ City/State/Zip Code *
County *
Mailing Address (P.O. Box if applicable) City/State/Zip
Phone Number *
Date of Birth *
MM
/
DD
/
YYYY
Notification
Email Address
By becoming a MORE Library card holder I accept the following responsibilities: *
Required
Signature/Signature of parent or Guardian (If under 18) & Date *
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