*Required Fields

*Name (Last Name, First Name):

*Home Address:

*Home Telephone:

Business Telephone:

Email:

Fax Number:

Age:
0-6 6-12 13-18 19-14 25-34 35-44 45-54 55-64 65-Over

Occupation:
Arts Business Clerical Homemaker Professional Skilled Worker Student Teacher Retired Other

Do you work in New Canaan?
 Yes
 No

Are you attending School?
 Yes
 No

Type of School:
None Elementary School Junior High School High School College Graduate School Technical School

I apply for the right to use the New Canaan Library and agree to follow the Library's regulations, to report promptly the loss of my card or change of address and to be fully responsible for materials borrowed on this card.