Jones Library Card Application - During COVID-19 Closure

2. <a href="/tarjeta" target="_self">Ver este formulario en español</a><br><br><em>PLEASE NOTE: This online application is for Amherst residents only.</em><br><br>Please fill out this form and a library staff member will complete your registration and email your library card information to you.

   Ver este formulario en español
   
   PLEASE NOTE: This online application is for Amherst residents only.
   
   Please fill out this form and a library staff member will complete your registration and email your library card information to you.

4. Home library*
   -- Select One --Jones Library

6. NOTE: Please enter your responses in ALL CAPITAL LETTERS

8. First name*

10. Middle name

12. Last name*

14. Preferred first name
    (if different)

16. Preferred last name
    (if different)

18. Date of birth*
    Date of birth

    mm/dd/yyyy

20. Are you currently a college student?*

    1. Yes
    2. No

22. Email address*

24. Phone number*

    please include dashes | example: 413-259-1234

26. Mailing address*

28. Apartment number

30. City*
    -- Select One --Amherst

32. State*
    -- Select One --Massachusetts

34. Zip code*

    example: 01002

36. Is this a PO Box address?

    1. Yes
    2. No

38. Please also provide a street address. Thanks!
    
    Street address*

40. Apartment number

42. City*
    -- Select One --Amherst

44. State*
    -- Select One --Massachusetts

46. Zip code*

    example: 01002

Leave This Blank:


48. Submit

* indicates a required field