Clatskanie Library District
Library Card Registration
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Primary User's Name   *
Primary User's Date of Birth *
Datum
Photo Identification # *
Photo ID expiration date *
Datum
Mailing Address *
Street Address (if different)
Phone number *
Additional Card Holder Name(s) and Date(s) of Birth
By digitally signing below I agree to abide by the rules of the Clatskanie Library. I understand that I am financially responsible for any item that may become lost or damaged while checked out to my account.  Please Sign: *
Please be prepared to mail or email a copy of your photo identification. If your identification does not have your current address, you will need to also supply proof of residency. Ex: lease, utility bill, or other type document or mail. We will contact you for this information.
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