LIBRARY CARD APPLICATION

Fill out the following form and submit it in order to obtain the right to check out materials from the Learning Resource Center.  All information on the form is required for processing.  You must be a resident of the five county service area of Chesapeake College.

I apply for the right to use the Chesapeake College Learning Resource Center and I agree to abide by the rules and regulations, to take good care of such material I may borrow, to pay all penalties and appropriate fees for lost or damaged materials charged to me and to give prompt notice of any change in my address.

FULL NAME:
		Last	First	MI
HOME ADDRESS:
		Street
		City, State
		Zip Code
SOC. SEC. NO:
EMAIL ADDRESS.:
HOME PHONE NO.:
EMPLOYER:
BUSS. ADDRESS:
BUSS. PHONE:
TODAY'S DATE:
DRIVER'S LIC. NO.:

If there is inaccurate information on this page, please send correction or comments to: lrcdesk@chesapeake.edu