Untitled Document

Application for Out-of-State LDS Materials


Last Name
First Name
Middle Initial
Mailing Address
City
State / Province
Zip Code
E-Mail Address
Phone (include area code)
Date of Birth
Sex
Contact Person: Please indicate the name, address and phone number of someone we can contact if we are unable to contact you (family member if possible):
Name
Address
Daytime Phone (include area code)
Are you registered with your local regional library? Note: you must be registered with your local Library for the Blind to apply for LDS services
If so, which regional library? (Name)
Home library patron number
Service Preferences Please indicate the format of books and service preferences:
Recorded Cassettes One book when one returned Send only titles I request
Braille Books One book when one returned Send only titles I request
Magazines on Cassette Ensign The Friend New Era
Magazines in Braille The Friend New Era