ÿþ<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> <html> <head> <title>WINDSOR LOCKS LIBRARY CARD REGISTRATION</title> <!-- Insert this code to the HEAD tags --> <style type="text/css"> body{ font-family:Verdana, Arial, Helvetica, sans-serif; background-image:url('greenbg4.gif'); background-color: #8fbc8f; <!-- a {text-decoration: none;} --> </style> <link rel="stylesheet" type="text/css" href="wlnew.css" /> </head> <body bgcolor="8fb8cf"> <table width="900" bgcolor="fff8dc" border="2" cellpadding="30" align="center"> <tr> <td> <p align="center"><img src="antique.jpg"><img src="wlpl10.jpg" alt= "Windsor Locks Public Library"></p> <table align="left" bgcolor="#ffe4c4" width="24%" cellpadding="20"> <tr> <td valign="top"><a href="siteindex.html">Site Map</a><br> <a href="http://www.eventkeeper.com/code/events.cfm?curOrg=WLOCKS">Programs<br> <br> <a href="http://ibistro.libraryconnection.info/uhtbin/cgisirsi/0/WNDSRLOCKS/0/1/1166/X/BLASTOFF?user_id=WNDSRLOCKSPUB&password=public"> My Account</a><br> <a href="cataloginfo.html">Our Catalog</a><br> <a href="http://www.iconn.org">Statewide Catalog</a><br><br> <a href="kidspage.html">Children s Page</a><br> <a href="emailalert.html">Email Alerts</a><br> </a> <a href="internet.html">Internet Policy</a><br> <a href="faq.html">Library FAQ's</a><br> <a href="READ.html">Reading</a><br> <a href="research.html">Research</a><br> <a href="search.html">Search Engines</a><br> <a href="websites.html">Web Resources</a><br> <a href="http://www.windsorlocksct.org/">Windsor Locks</a><br><br> <br> <a href="mailto:epearce@libraryconnection.info">Contact Us</a><br> <a href="http://www.windsorlockslibrary.org/index.html">Home</a><br> </td> </tr> </table> <table align ="top" width="75%" cellpadding="20"> <tr> <td> <h4 align="center"><b>~LIBRARY CARD REGISTRATION / RENEWAL~</h4> <p align="CENTER"> <img src="wlplcard.jpg"width="250" height="156"></P> <P ALIGN="LEFT"> Welcome to Windsor Locks Public Library! We are pleased to offer Windsor Locks residents the opportunity to register for a library card or update registration information (such as address or telephone changes) online. Please fill in ALL of the fields below and press SUBMIT to register for your new library card or update your current record. Your library card must show your full legal name as it appears on your license. No nicknames, please!<br><br> Your new card will be mailed to you within a week along with information about our library's policies and collections. You must visit the library and present a picture ID and proof of address in order to activate your card. Borrowers under 16 years of age must appear in person with a parent or guardian who CAN provide an ID and proof of address. For renewals no new card will be issued unless requested by the borrower in person.<br><br> If you have a prior card in our system with outstanding fines or overdue materials you will need to clear up these obligations before we can issue your new Windsor Locks card. Please call us at 627-1495 if you have questions about your library record. For more information on library cards at Windsor Locks Public Library, visit our <a href="cards.html">Library Cards page</a>.</p><br> <form method="post" enctype="multipart/form-data" action="http://pub13.bravenet.com/emailfwd/senddata.php" accept-charset="utf-8"> <input type="hidden" name="usernum" value="1098423961"> <input type="hidden" name="cpv" value="2"> <!-- DO NOT CHANGE OR REMOVE THE 3 TAGS ABOVE THIS COMMENT--> <table border="0" cellpadding="0" cellspacing="0" align="center"> <tr> <td><h3 style="border-bottom:1px solid black;">Windsor Locks Public Library Card Registration</h3></td> </tr> <tr> <td> <label style="float:left;width:140px;">New or renewal?</label><span name="registration" style="display:block;width: 400px;"><input type="radio" name="registration" id="registration1radioOption" value="new" style="vertical-align: middle;border:0px;background-color:transparent" checked><label for="registration1radioOption">New registration</label><input type="radio" name="registration" id="registration2radioOption" value="renew" style="vertical-align: middle;border:0px;background-color:transparent"><label for="registration2radioOption">Renewal</label></span><div style="clear:left;height:20px;"> </div> <label for="FirstName" style="float:left;width:140px;">First Name:</label><input type="text" name="FirstName" id="FirstName" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="MI" style="float:left;width:140px;">Middle Initial</label><input type="text" name="MI" id="MI" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="LastName" style="float:left;width:140px;">Last Name:</label><input type="text" name="LastName" id="LastName" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="PhoneNumber" style="float:left;width:140px;">Home Phone:</label><input type="text" name="PhoneNumber" id="PhoneNumber" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="Cellphone" style="float:left;width:140px;">Cell Phone:</label><input type="text" name="Cellphone" id="Cellphone" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="emailto" style="float:left;width:140px;">Email:</label><input type="text" name="emailto" id="emailto" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="Address" style="float:left;width:140px;">Address:</label><input type="text" name="Address" id="Address" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="Apt" style="float:left;width:140px;">Apartment Number:</label><input type="text" name="Apt" id="Apt" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="City" style="float:left;width:140px;">City:</label><input type="text" name="City" id="City" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="State" style="float:left;width:140px;">State:</label><input type="text" name="State" id="State" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="ZipPostalCode" style="float:left;width:140px;">Zip/Postal Code:</label><input type="text" name="ZipPostalCode" id="ZipPostalCode" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="DOB" style="float:left;width:140px;">Date of Birth (mm/dd/yyyy):</label><input type="text" name="DOB" id="DOB" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label style="float:left;width:140px;">Gender</label><span name="gen" style="display:block;width: 400px;"><input type="radio" name="gen" id="gen1radioOption" value="Male" style="vertical-align: middle;border:0px;background-color:transparent" checked><label for="gen1radioOption">Male</label><input type="radio" name="gen" id="gen2radioOption" value="Female" style="vertical-align: middle;border:0px;background-color:transparent"><label for="gen2radioOption">Female</label></span><div style="clear:left;height:20px;"> </div> <label for="Parent" style="float:left;width:140px;">Parent/Guardian (if under 16):</label><input type="text" name="Parent" id="Parent" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="Workphone" style="float:left;width:140px;">Work Phone:</label><input type="text" name="Workphone" id="Workphone" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <label for="Prioraddress" style="float:left;width:140px;">Prior Address:</label><input type="text" name="Prioraddress" id="Prioraddress" value="" maxlength="" style="width:200px;"><div style="clear:left;height:20px;"> </div> <div style="clear:left;height:10px;"> </div> </td> <tr> <td align="right"> <!-- YOU CAN MODIFY THE TEXT WITHIN VALUE="" TO MODIFY YOUR BUTTON TEXT--> <input type="submit" value=" Submit "> <input type="reset" value=" Reset "> </td> </tr> </table> </form> <p align="center"><img src="bookstack.gif" border="0" alt="books"> </p> </TD> </TR> </TABLE> </body> </html>