Application for Homebound Delivery Service

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Seekonk Public Library
Application for Homebound Delivery Service

Name _____________________________________    Date of Birth __________________
Address _________________________________________     Apt # _________________
Phone _________________     Email Address ____________________________________

Signature ______________________________________              Date _________________

I am interested in: (Please check all that apply) ____ Paperbacks     ____Videos    ____ DVDs

____ Large Print Books    ____ Regular Print Books    ____ Magazines    ____ Audiobooks on CD

Please list your favorite authors and topics to help us select titles of interest to you.

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Deliveries are provided by library volunteers.

If you have trouble filling out this form, the Adult Services Librarian will be happy to assist you.

Adult Services Department 508-336-8230, ext. 5130
E-mail: library@seekonkpl.org