Kesler Membership Application

 

Title:	(...please select one...) Dr. Rev. Pastor Rabbi Imam Mr. Ms.
First name:
Last name:
Mailing address: (Note: we are unable to send items to post office boxes. Please supply a street address to which you want materials sent.)
Phone number:
Your e-mail address:
Name of church/religious body:
Denomination/religious affiliation:
I would like to enroll as a member of the Kesler Circulating Library and to use its services. I understand my privileges and responsibilities as a member as described on the KCL Membership Information page. I agree to return materials promptly and to comply with KCL policies. I shall notify you promptly when my address changes or when I wish to withdraw as a member. If I am enrolled in a degree program, I agree to use my KCL membership primarily to support my ministerial work. I accept these conditions of membership: Yes No

	15977
Security Test:
Please type the number shown above this box to help us avoid spam.