Bexley Libraries Membership Form

*Family Name:

*Title:
Select... Mr Mrs Miss

*Other Names:

*Address:

(This is where your Library Card will be sent)

*Postcode:

Telephone:

Age:

Date of Birth:
/ /

E-mail Address:

School (if applicable):

If you have a different contact address to the one entered above, please enter it below:

Address:

Postcode:

Telephone:

*The Library you use most will be:
Please Select... Bexley Village Library Blackfen Library Bostall Library Central Library Crayford Library Erith Library North Heath Library Sidcup Library Slade Green Library Thamesmead Library Upper Belvedere Library Welling Library Mobile Library

Please help us provide services which suit everyone by completing this section

Gender:
Select... Male Female

Ethnicity:
Please Select... White-British (non-Irish) White Irish White - Other Mixed - White & Asian Mixed - White & Black Caribbean Mixed - White & Black African Mixed - Other Asian - Indian Asian - Pakistani Asian - Bangladeshi Asian - Other Black or Black British - Carribbean Black or Black British - African Chinese Other Black or Black British - Other

Do you consider yourself to have a disability:

Under the terms of the Data Protection Act, this information is held on computer for management information and our own membership distribution purposes only.

*I declare that the information on this form is correct.

*I agree to abide by the Library Byelaws, displayed in all libraries, and accept responsibility for all items borrowed on my ticket.

*I understand that a charge, for which I will be responsible, will be made if items are returned late. Should any items I borrow be lost or damaged (for whatever reason) then a separate charge, for which I will be responsible, will be made at the sole discretion of London Borough of Bexley.

*I also understand that if I do not use my Library Card for a period of two years, I will need to rejoin the Library Service and show proof of address.

*Full Name:

*Date:

Guarantor
(If you are under 18, the details of a parent or guardian is required below and your Library Card will be posted to them. You will need to bring proof of their ID on your first visit)

I accept  responsibility for items borrowed by the person named on this form and for any charges incurred by that person.

Name of Parent/Guardian:

Address (if different):

Postcode:

Full Name:

Date:

Are you joining as a result of:

National Membership publicity, (e.g. advert in National Newspaper)
Local Publicity, (e.g. advert in Local Newspaper)
Bexley Magazine Promotion
Other...Please state below: