Form Center

2. Instructions
   This application is designed to collect the information needed by Placer County Library Staff to create and issue an E-card to utilize online library resources. This card will not allow for the check-out of physical library materials. An e-card can be converted to full card at a library during open hours with an ID with current address or ID with address confirmation documentation (Utility Bill, etc...). This card remains active as long as you continue to use services. If you have any questions you can e-mail: [email protected]
4. Once your application has been processed, your e-card information will be sent via the e-mail address you provided.
6. Last Name*
7. First Name*
9. Preferred Physical Library Location*
   -- Select One --AuburnColfaxForesthillGranite BayKings BeachRocklinTahoe City

   Please pick from the dropdown the physical library location you are most likely to visit.

10. Date of Birth*
    MM/DD/YYYY
11. Name of School

    If you are a student please let us know what school you attend

13. E-mail Address*
14. Confirm E-Mail Address*
15. Zip Code
17. Mailing Address

    You card will be mailed to the address provided.

18. City
20. State
21. Primary Phone Number*
22. Preferred Method of Receiving Library Notices
    -- Select One --E-MailText Messaging

    Please select the way you prefer to receive notices from the library.
24. Mobile Carrier

    Required if you choose to receive text notifications. (Example: Verizon, AT&T, etc...)

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field