Application


Name (First and Last):

Date (MM-DD-YY):

Mailing Address:

City:

Zip Code:

Telephone:
Home Work
E-mail Address:

Residence Address:

Occupation:

Distance to Nearest Library:

Frequency of Mail:

Do you want books sent automatically based on the infomation in this profile?

Do you want books by request only

Do you want to request a pin number that will enable you to put holds on books and check the status of your account from your home computer? 

Adults in household (Names):

Favorite Authors:


Enter specific selections (or other interests) here:

Place the individual adult's number next to the type of books he/she would like to receive:


Fiction
Adventure Alaskana
Audios Best Sellers
Classics Fantasy
Historical Fiction Horror
Humor Mysteries
Romances Science Fiction
Short Stories Videos
Westerns  
   
Non-Fiction
Alaskana Religious/Inspirational
Adventure Science
Biography Nature
Best Sellers Art Technique
Health Art (specify below)
Crafts History (specify below)
Poetry Sports (specify below)
Psychology Self-Help
How-to Travel

Children in household (Names):

  1.   Year of Birth 
  2.   Year of Birth 
  3.   Year of Birth 
  4.   Year of Birth 

Place the child's number (from last step) next to the type of books he/she would like to receive:


Fiction
Alaskana Historical Fiction
Adventure Mysteries
Animals Romances
Classics Science Fiction
Fantasy Short Stories
Horror Humor
Videos Audios

Non-Fiction
Alaskana Religious/Inspirational
Adventure Science
Biography Nature
Health Arts and Crafts
Hobbies History
Poetry Sports (specify below)

Child's Favorite Authors:


Child's specific selections (or other interests) here:

 Are your children enrolled in correspondence study programs? 

What percentage should we send each shipment?
%Fiction %Non-Fiction


Additional Comments: The more you tell us, the more likely we will pick books you will enjoy!



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