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2. Last Name*
3. First Name*
4. Middle Initial*
5. Birth Date*
   Birth Date
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. County*
16. I live...*

    1. inside Faribault city limits.
    2. in rural Rice County.
    3. outside of Faribault and Rice County.
17. Please enter a 4 digit PIN number*
19. Email Address*
20. Phone number
    Please include area code.
21. If under 18 years old, parent or guardian's full name.
23. After submitting this form, Library staff will process your request and email your electronic library card number to your email. This number, along with your PIN number will enable you to use the Library's online resources ONLY. When the Library opens, please present your photo ID with proof of address to staff at the Library's Circulation Desk to receive your physical library card.
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field