2. Before you fill out this form, please know that you must provide photo identification (ND issued driver's license or a ND issued non-driver identification card) and proof of current address in order to retrieve your library card. (Children and teens under 18 can be issued cards under a parent or legal guardian's ID)*

   1. I can provide the required North Dakota ID

   1. I am willing to pay a $30 per year non-resident fee
4. Full Name (First, Middle, Last)*
6. Mailing Address
8. Street/P.O. Box*
10. City*
11. State*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
12. Zip Code*
14. Street Address (If Different than above)
16. Street
17. City
18. State
    -- Select One --AlabamaAlaskaArizona ArkansasCaliforniaColorado ConnecticutDelawareFlorida GeorgiaHawaii IdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevada New Hampshire New Jersey New Mexico New York North Carolina North DakotaOhio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South DakotaTennessee Texas Utah VermontVirginiaWashington West VirginiaWisconsinWyoming
19. Zip Code
21. Would you like to receive notifications about hold requests and overdue items by text message?*

    1. Yes

    1. No
23. Phone Number*
24. Phone Type*
    -- Select One --CellHomeWork
26. Alternate Phone Number
27. Phone Type
    -- Select One --CellHomeWork
29. Email Address
31. 4-Digit PIN (Personal Identification Number - A PIN is required to access your account and electronic resources online)*
33. Birthdate*
    Birthdate

35. Children ages 17 and under must have a parent/legal guardian present with required ID in order to retrieve a library card.

37. Patrons under 18:
39. Parent/Legal Guardian Name
40. Parent/Legal Guardian Phone Number
42. Relationship to Card Holder
44. Parent/Legal Guardian is responsible for all library card activity and fines accrued by minor.
    Please read carefully:
    
    As a Bismarck Veteran's Memorial Public Library cardholder, I agree to:
    
    Abide by library rules regarding behavior, public computer use and borrowing materials.
    Be responsible for the items and charges incurred on this card.
    Report my library card's loss or theft immediately.
    Inform the library of any changes in my address, telephone number, or email address.
    
    Please allow 1-2 business days for processing of online library card requests. After you have submitted this application, you will have 30 days to retrieve your new card.
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field