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Wheeler Library Card Sign-Up
Application Type
*
New Application
Renewal
Lost Card
Name
*
First Name
Last Name
Legal Name (if different)
First Name
Last Name
Date of Birth (if under 18)
(mm/dd/yyyy)
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Add Mailing Address (if different from residence)
Yes
Mailing Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Contact Information
Email
*
Verify Email
*
Phone
*
Would you like to receive our weekly email newsletter?
*
Yes
No
Acceptance of Terms
*
I AGREE TO ABIDE BY STATE LIBRARY LAWS AND LOCAL LIBRARY REGULATIONS AND UNDERSTAND THAT I AM RESPONSIBLE FOR ALL MATERIALS BORROWED WITH MY CARD.
Yes
Photo ID
*
Please upload a copy of your Connecticut driver license or state ID with a North Stonington address. Parents may provide identification on their child's behalf.
Electronic Signature
*
Date
*
(mm/dd/yyyy)