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Rotherham Library and Information Service

I wish to apply to be registered as a member of Rotherham Library & Information Service. I undertake to abide by all the current regulations regarding the use of services, loans of items and current legislation.

* Denotes a mandatory field

Reference Number:

FYN1UU458437

* Title:

* Surname:

* Forename:

* Home Address:

	Address Line 1
	Address Line 2
	Town / City
	County
	Postcode

Home Telephone Number:
(inc. STD)

Mobile Telephone Number:

Email Address:

* Date of Birth:
(dd/mm/yyyy)

Can we use this email address to contact you:

Can we contact you by SMS/text:

* At which Rotherham Library do you wish to collect your ticket from:

Today's Date:

20/08/2008

The information you provide will be used to resolve your enquiry and provide the services you have requested. It will be shared with other Council departments only where necessary for those purposes or where we have a statutory duty to disclose information.