Name: (First and Last Name as they appear on the photo ID)


Birthdate* (mm/dd/yyyy)


Identification:


Additional Information:



Residence Address:


Mailing Address (If different from residence):



I assume responsibility for all materials checked out on and all charges incurred by the use of this card. I understand that Library fees, including nonrefundable service charge, collection, Texshare, and ILL fees, are set by the Austin City Council and are subject to change. To minimize liability, I will inform the Library immediately of a change of address, email address or if the card becomes lost or stolen.