Request for Homebound Delivery Service • Morgan County Public Library

Name:*

Email Address:

Phone Number:*

Street Address:*

City:*

Zip Code:*

Emergency Contact Name (Friend or Relative):*

Emergency Contact Phone Number:*

Preferred Formats (check all that apply):

Preferred Genres (check all that apply):

Authors you have enjoyed reading:

Subjects you enjoy reading about:

Please list any subject matter that may be offensive/of no interest to you:

Do you have an MCPL library card?*

If yes, what is your library card number?

Number of items you would like to receive each delivery:

Do you need year-round service, or just during certain months?

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