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410.827.5860 · TTY users call via Maryland Relay · P.O. Box 8 · 1000 College Circle · Wye Mills MD 21679

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LIBRARY PATRON REGISTRATION

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):

SOC. SEC. NO:

HOME PHONE NO.:
DRIVER'S LIC. NO.:
EMAIL ADDRESS:
HOME ADDRESS:
Street
City, State
Zip
EMPLOYER:
INSTITUTION ATTENDING:
BUS. ADDRESS:
 BUS. PHONE:

 

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