Reciprocal Card Application

Reciprocal Library Card Application

This form allows you to apply for a membership through our website,however, it is not secure. If you are not comfortable sending your personal information over the internet, you can register in person or send our printer friendly form to us by fax at (269) 324-9222 or by mail: Portage District Library Circulation Department, 300 Library Ln, Portage, MI 49002.

Your are entitled to a free reciprocal membership if you live within and have a current resident membership with the following library districts: Battle Creek, Comstock, Kalamazoo, Parchment, Plainwell, Richland, Schoolcraft, or Vicksburg. All others must register in person and pay an annual membership fee. If you are unsure whether or not you qualify, please call (269)329-4544.

Name

Birth Date

(mm/dd/yyyy)

Address

Gender

Male Female

Zip Code

*not required

Telephone

Resident member of

Would you like to receive a copy of our program brochure? Yes No

I understand that I am responsible for all use of this membership, including any overdue charges, lost/damage fees, or internet violations incurred by its use. All information in your library record is confidential. Portage District Library is prohibited by law from revealing any personally identifying information.

Below are two choices for printer friendly versions of this form. If you choose to use the PDF, you will need to have a copy of Adobe® Reader 6.0. or equivalent. The library is not responsible for any computer support relating to this download.

Printer Friendly Format (MS Word)

Printer Friendly Format (PDF)

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