Form – Outreach Registration Outreach Registration "*" indicates required fields Organization / Group Name Name*As it appears on your government issued ID. First Last Preferred Name (if different from first name) Would you like to keep track of your borrowing history?* Yes No Address* Street Address City Postal Code Phone*Alternate PhoneEmail*For courtesy & overdue notices Age Category*To help us better plan programs and collections, please select the following demographic questions: 0-4 5-9 10-13 14-17 18-24 25-34 35-44 45-54 55-64 65-74 OVER 75 Prefer not to say Language (other than English) spoken at home Date of Birth (if under 16)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901190018991898189718961895189418931892189118901889188818871886Membership Terms and Agreement**Your card must be presented each time materials are borrowed *The registered cardholder is responsible for all materials issued on this card *Please notify the library of any change in address *Report a lost or stolen card immediately *A fee will be charged for the replacement of this card Materials may be renewed in person, by telephone or online. Personal information contained in this form is collected under the authority of the Public Libraries Act, R.S.O 1990, C44 for the purpose of delivering service to our registered customers. Questions regarding the collection of this information should be directed to: Chief Executive Officer, Aurora Public Library, 15145 Yonge Street, Aurora, Ontario, L4G 1M1 (905) 727-9494 I agree to the privacy policy.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
