EmailMe Form - TGC Homebound Service Application

Name *

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Address

Street Address City State / Province / Region Postal / Zip Code

Phone *

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Email Address

Do you already have a library card? (If no, we will set up a library account for you)

What is your library card number?

Preferred Language

Number of books you would like to borrow each month

Reading Preference

Reading Interests - Fiction (check all that apply)

Other Fiction Interests - provide details

Reading Interests - Non-fiction (check all that apply)

Other non-fiction interests - provide details

Favorite authors (fiction and/or non-fiction):