Clatskanie Library District
Patron Registration Form
Email address *
Primary User's Name, Date of Birth & Gender: *
Photo Identification # and Expiration *
Email *
Full Mailing & Street Address *
Phone number *
Additional Card Holder Name (s), Date of Birth & Gender
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 and Date: *
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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