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2. First Name*
3. Middle Initial
4. Last Name*
6. Date of Birth
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. (If Mobile Phone) Who is the Cell Phone Carrier?
16. Email Address
18. Photo ID Front

    Please attach image of Driver's License or State ID both front and back. If your ID does not show a Madison Heights address, please include Proof of Residency as well.

19. Photo ID Back

    Please attach image of Driver's License or State ID both front and back. If your ID does not show a Madison Heights address, please include Proof of Residency as well.

21. Proof of Residency

    If Madison Heights is not on your ID, please provide: mortgage or rent receipt, utility bill in your name, voter's registration card. If needed a staff member will contact you.

23. Notification Preference*
    -- Select One --EmailPhone CallText Message

    Select one.
25. There are 2 different library card styles available:
    
27. Select your library card style*

    1. Books

    1. Baby Yoda
29. A library staff member will contact you within 3 business days.

    If you need a library card sooner, please come to the library in-person with photo ID and proof of residency.

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field