Carroll and Madison Library System

 EMAIL     PHONE/MAIL      TXT MSG (PROVIDER: □ VERIZON  □ AT&T  Other __________________)

Staff Use Only

PHOTO ID/PROOF OF MAILING ADDRESS:
 DL    State ID    Mail    Other_________________________________________________

ID Number:_____________________  Date of Application:_________________  Initials:__________

Staff Use Only
   
LAST NAME:___________________________________ FIRST________________________________ MIDDLE INITIAL_____  2001_______-_______________ 

 
 
—   Residents of Carroll or Madison counties or contiguous counties including southern Missouri are eligible for a free card. To obtain a library card, you must present proof of current address, e.g. driver’s license, utility bill, property tax receipt, or printed identification (medical card, company ID).