Books By Mail Registration Form How did you hear about this service? Name* First Last Birthdate (mm/dd/yyyy)* MM slash DD slash YYYY Do you have an Arlington Library Card?* Yes No Library Card Number* Do you live in a Senior Living Community?* Yes No If yes, which one?* Address* Street Address Address Line 2 City ZIP Code You must be an Arlington resident to receive Books by Mail service.Phone*Email (Optional) Secondary Contact Person Information (Optional)Name of person (family member, friend or caregiver) to call if we cannot reach you for an extended period of timeContact Person Name First Last Contact Person Relationship Contact Person PhoneContact Person Email Who will be the primary contact?* Patron Secondary Contact Preferred method of communication* Telephone Email Note/Mail Please briefly explain why you are requesting this service*Reader QuestionnairePlease help us meet your reading needs by answering the following questionsWhich print format(s) would you like to receive? (Check all that apply)* Regular Type Books Large Print Books No Preference NOTE: If physical or visual impairments make it difficult to read print, please ask us about the free Talking Book service.Do you use an electronic device (e-reader or tablet) such as Kindle or iPad to read e-books?* Yes No Would you like help accessing the library’s eCollectionon your device?* Yes No Would you like us to make selections for you?* Yes Yes, but I will also make special requests No, I will contact you with special requests only Would you like us to send books to you as soon as we receive your returns (turnaround service)?* Yes No, please wait until I request books If you have selected turnaround service, how many books would you like to receive at a time?* 1 - 2 3 - 4 5 or more (only if you make requests) (Please note that this is approximate – you may receive more or fewer depending on availability and U.S. Postal Service delivery times)Which genres do you prefer? (Select as many as you wish)*ClassicsDetective/MysteryFantasyHistorical FictionHorrorHumorLiterary FictionPoetryPolitical ThrillersRomanceSci-Fi ThrillerWesternsNon-Fiction TopicsBiographyCookingCurrent EventsHealthHistoryOtherSelect as many as you wish by pressing the "CTRL" key and your selectionOther genres or topics What are your particular interests?Who are your favorite authors?Additional CommentsI give permission to the Books by Mail Service at Arlington Public Library to keep a record of my reading history in order to select appropriate materials for me.* I agree I understand that I will not be charged late or overdue fines but I will be charged a replacement fee for any books that are lost.* I agree Now What? Once we receive your application, we will contact you, usually by phone, to confirm your preferences. We will then set up or modify your library account and get you started with the service.NameThis field is for validation purposes and should be left unchanged. Δ
